Martínez de Juan Fernando, Navarro Samuel, Machado Isidro
Unit of Gastroenterology and Digestive Endoscopy, Instituto Valenciano de Oncología, 46009 Valencia, Spain.
Department of Pathology, Universidad de Valencia, 46010 Valencia, Spain.
Cancers (Basel). 2024 Jun 25;16(13):2321. doi: 10.3390/cancers16132321.
The low positive predictive value for lymph node metastases (LNM) of common practice risk criteria (CPRC) in T1 colorectal carcinoma (CRC) leads to manyunnecessary additional surgeries following local resection. This study aimed to identify criteria that may improve on the CPRC.
Logistic regression analysis was performed to determine the association of diverse variables with LNM or 'poor outcome' (LNM and/or distant metastases and/or recurrence) in a single center T1 CRC cohort. The diagnostic capacity of the set of variables obtained was compared with that of the CPRC.
The study comprised 161 cases. Poorly differentiated clusters (PDC) and tumor budding grade > 1 (TB > 1) were the only independent variables associated with LNM. The area under the curve (AUC) for these criteria was 0.808 (CI 95% 0.717-0.880) compared to 0.582 (CI 95% 0.479-0.680) for CPRC. TB > 1 and lymphovascular invasion (LVI) were independently associated with 'poor outcome', with an AUC of 0.801 (CI 95% 0.731-0.859), while the AUC for CPRC was 0.691 (CI 95% 0.603-0.752). TB > 1, combined either with PDC or LVI, would reduce false positives between 41.5% and 45% without significantly increasing false negatives.
Indicating additional surgery in T1 CRC only when either TB > 1, PDC, or LVI are present could reduce unnecessary surgeries significantly.
T1期结直肠癌（CRC）中，常用实践风险标准（CPRC）对淋巴结转移（LNM）的阳性预测值较低，导致局部切除术后出现许多不必要的额外手术。本研究旨在确定可能优于CPRC的标准。
在一个单中心T1期CRC队列中，进行逻辑回归分析以确定各种变量与LNM或“不良预后”（LNM和/或远处转移和/或复发）之间的关联。将获得的变量集的诊断能力与CPRC的诊断能力进行比较。
该研究包括161例病例。低分化簇（PDC）和肿瘤芽生分级>1（TB>1）是与LNM相关的唯一独立变量。这些标准的曲线下面积（AUC）为0.808（95%CI 0.717-0.880），而CPRC的AUC为0.582（95%CI 0.479-0.680）。TB>1和淋巴管侵犯（LVI）与“不良预后”独立相关，AUC为0.801（95%CI 0.731-0.859），而CPRC的AUC为0.691（95%CI 0.603-0.752）。TB>1与PDC或LVI联合使用，可减少41.5%至45%的假阳性，而不会显著增加假阴性。
仅在存在TB>1、PDC或LVI时才对T1期CRC进行额外手术，可显著减少不必要的手术。
