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Tytuł:
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Pedunculated Morphology of T1 Colorectal Tumors Associates With Reduced Risk of Adverse Outcome.
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Autorzy:
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Kessels K; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands.
Backes Y; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Elias SG; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
van den Blink A; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Critical Care Medicine, Vrije Universiteit University Medical Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Offerhaus GJA; Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
van Bergeijk JD; Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands.
Groen JN; Department of Gastroenterology and Hepatology, Sint Jansdal Hospital, Harderwijk, The Netherlands.
Seerden TCJ; Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, The Netherlands.
Schwartz MP; Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands.
de Vos Tot Nederveen Cappel WH; Department of Gastroenterology and Hepatology, Isala Hospital, Zwolle, The Netherlands.
Spanier BWM; Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands.
Geesing JMJ; Department of Gastroenterology and Hepatology, Diakonessenhuis Hospital, Utrecht, The Netherlands.
Kerkhof M; Department of Gastroenterology and Hepatology, Groene Hart Hospital, Gouda, The Netherlands.
Siersema PD; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Gastroenterology and Hepatology, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands.
Didden P; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Boonstra JJ; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden University, Leiden, The Netherlands.
Herrero LA; Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands.
Wolfhagen FHJ; Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
Ter Borg F; Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands.
van Lent AU; Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, The Netherlands.
Terhaar Sive Droste JS; Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, Den Bosch, The Netherlands.
Hazen WL; Department of Gastroenterology and Hepatology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
Schrauwen RWM; Department of Gastroenterology and Hepatology, Bernhoven Hospital, Uden, The Netherlands.
Vleggaar FP; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Laclé MM; Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Moons LMG; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. Electronic address: .
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Corporate Authors:
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Dutch T1 Colorectal Cancer Working Group
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Źródło:
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Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association [Clin Gastroenterol Hepatol] 2019 May; Vol. 17 (6), pp. 1112-1120.e1. Date of Electronic Publication: 2018 Aug 18.
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Typ publikacji:
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Journal Article; Multicenter Study
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Język:
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English
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Imprint Name(s):
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Original Publication: Philadelphia, PA : W.B. Saunders for the American Gastroenterological Association, 2003-
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MeSH Terms:
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Neoplasm Staging*
Colonoscopy/*methods
Colorectal Neoplasms/*diagnosis
Neoplasm Recurrence, Local/*epidemiology
Risk Assessment/*methods
Aged ; Colorectal Neoplasms/epidemiology ; Colorectal Neoplasms/secondary ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local/diagnosis ; Netherlands/epidemiology ; Prognosis ; Retrospective Studies ; Risk Factors ; Survival Rate/trends ; Time Factors
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Contributed Indexing:
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Keywords: Colon Cancer; Colonoscopy; Endoscopic Mucosal Resection; Prognostic Factor
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Entry Date(s):
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Date Created: 20180822 Date Completed: 20200923 Latest Revision: 20200923
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Update Code:
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20240104
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DOI:
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10.1016/j.cgh.2018.08.041
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PMID:
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30130623
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Background & Aims: Risk stratification for adverse events, such as metastasis to lymph nodes, is based only on histologic features of tumors. We aimed to compare adverse outcomes of pedunculated vs nonpedunculated T1 colorectal cancers (CRC).
Methods: We performed a retrospective study of 1656 patients diagnosed with T1CRC from 2000 through 2014 at 14 hospitals in The Netherlands. The median follow-up time of patients was 42.5 months (interquartile range, 18.5-77.5 mo). We evaluated the association between tumor morphology and the primary composite end point, adverse outcome, adjusted for clinical variables, histologic variables, resection margins, and treatment approach. Adverse outcome was defined as metastasis to lymph nodes, distant metastases, local recurrence, or residual tissue. Secondary end points were tumor metastasis, recurrence, and incomplete resection.
Results: Adverse outcome occurred in 67 of 723 patients (9.3%) with pedunculated T1CRCs vs 155 of 933 patients (16.6%) with nonpedunculated T1CRCs. Pedunculated morphology was independently associated with decreased risk of adverse outcome (adjusted odds ratio [OR], 0.59; 95% CI, 0.42-0.83; P = .003). Metastasis, incomplete resection, and recurrence were observed in 5.8%, 4.6%, and 3.9% of pedunculated T1CRCs vs 10.6%, 8.0%, and 6.6% of nonpedunculated T1CRCs, respectively. Pedunculated morphology was independently associated with a reduced risk of metastasis (adjusted OR, 0.62; 95% CI, 0.41-0.94; P = .03), incomplete resection (adjusted OR, 0.57; 95% CI, 0.36-0.91; P = .02), and recurrence (adjusted hazard ratio, 0.52; 95% CI, 0.32-0.85; P = .009). Metastasis, incomplete resection, and recurrence did not differ significantly between low-risk pedunculated vs nonpedunculated T1CRCs (0.8% vs 2.9%, P = .38; 1.5% vs 0%, P = .99; 1.5% vs 0%; P = .99). However, incomplete resection and recurrence were significantly lower for high-risk pedunculated vs nonpedunculated T1CRCs (6.5% vs 12.5%; P = .007; 4.4% vs 8.6%; P = .03).
Conclusions: In a retrospective study of patients with T1CRC, we found pedunculated morphology to be associated independently with a decreased risk of adverse outcome in a T1CRC population at high risk of adverse outcome. Incorporating morphologic features of tumors in risk assessment could help predict outcomes of patients with T1CRC and help identify the best candidates for surgery.
(Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.)
Comment in: Clin Gastroenterol Hepatol. 2019 May;17(6):1035-1036. (PMID: 30315946)
