Amsterdam University Medical Centers location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands.
Amsterdam University Medical Centers location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands.
Gastroenterology. 2022 Jul;163(1):174-189. doi: 10.1053/j.gastro.2022.04.010. Epub 2022 Apr 15.
BACKGROUND & AIMS: Deep submucosal invasion (DSI) is considered a key risk factor for lymph node metastasis (LNM) and important criterion to recommend surgery in T1 colorectal cancer. However, metastatic risk for DSI is shown to be low in the absence of other histologic risk factors. This meta-analysis determines the independent risk of DSI for LNM.
Suitable studies were included to establish LNM risk for DSI in univariable analysis. To assess DSI as independent risk factor, studies were eligible if risk factors (eg, DSI, poor differentiation, lymphovascular invasion, and high-grade tumor budding) were simultaneously included in multivariable analysis or LNM rate of DSI was described in absence of poor differentiation, lymphovascular invasion, and high-grade tumor budding. Odds ratios (OR) and 95% CIs were calculated.
Sixty-seven studies (21,238 patients) were included. Overall LNM rate was 11.2% and significantly higher for DSI-positive cancers (OR, 2.58; 95% CI, 2.10-3.18). Eight studies (3621 patients) were included in multivariable meta-analysis and did not weigh DSI as a significant predictor for LNM (OR, 1.73; 95% CI, 0.96-3.12). As opposed to a significant association between LNM and poor differentiation (OR, 2.14; 95% CI, 1.39-3.28), high-grade tumor budding (OR, 2.83; 95% CI, 2.06-3.88), and lymphovascular invasion (OR, 3.16; 95% CI, 1.88-5.33). Eight studies (1146 patients) analyzed DSI as solitary risk factor; absolute risk of LNM was 2.6% and pooled incidence rate was 2.83 (95% CI, 1.66-4.78).
DSI is not a strong independent predictor for LNM and should be reconsidered as a sole indicator for oncologic surgery. The expanding armamentarium for local excision as first-line treatment prompts serious consideration in amenable cases to tailor T1 colorectal cancer management.
深度黏膜下浸润（DSI）被认为是淋巴结转移（LNM）的关键危险因素，也是推荐 T1 结直肠癌手术的重要标准。然而，在没有其他组织学危险因素的情况下，DSI 的转移风险较低。本荟萃分析旨在确定 DSI 对 LNM 的独立风险。
纳入合适的研究以建立单变量分析中 DSI 对 LNM 的风险。为了评估 DSI 是否为独立危险因素，如果同时在多变量分析中纳入危险因素（如 DSI、分化不良、淋巴管血管侵犯和高级别肿瘤芽生）或在缺乏分化不良、淋巴管血管侵犯和高级别肿瘤芽生的情况下描述 DSI 的 LNM 率，则研究符合入选条件。计算比值比（OR）和 95%置信区间（CI）。
共纳入 67 项研究（21238 例患者）。总体 LNM 率为 11.2%，DSI 阳性癌症的 LNM 率显著更高（OR，2.58；95%CI，2.10-3.18）。8 项研究（3621 例患者）纳入多变量荟萃分析，未将 DSI 视为 LNM 的显著预测因子（OR，1.73；95%CI，0.96-3.12）。与 LNM 与分化不良（OR，2.14；95%CI，1.39-3.28）、高级别肿瘤芽生（OR，2.83；95%CI，2.06-3.88）和淋巴管血管侵犯（OR，3.16；95%CI，1.88-5.33）显著相关相反。8 项研究（1146 例患者）分析 DSI 作为单一危险因素；LNM 的绝对风险为 2.6%，汇总发生率为 2.83（95%CI，1.66-4.78）。
DSI 不是 LNM 的强独立预测因子，应重新考虑将其作为肿瘤手术的唯一指标。局部切除作为一线治疗方法的范围不断扩大，促使我们认真考虑在合适的情况下调整 T1 结直肠癌的管理。
