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ORIGINAL RESEARCH article

Front. Oncol.
Sec. Gastrointestinal Cancers: Colorectal Cancer
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1475270
This article is part of the Research Topic Sentinel Lymph Node Mapping in Minimally Invasive Rectal Cancer Surgery View all articles

Comparative prediction of lymph node metastasis in pT1 colorectal cancer among Western and Japanese guidelines

Provisionally accepted
Fumiaki Tanino Fumiaki Tanino 1Ken Yamashita Ken Yamashita 1*Shin Morimoto Shin Morimoto 1*Yudai Takehara Yudai Takehara 1*Noriko Yamamoto Noriko Yamamoto 1*Yuki Kamigaichi Yuki Kamigaichi 1*Tomoyuki Nishimura Tomoyuki Nishimura 1*Hidenori Tanaka Hidenori Tanaka 1*Hidehiko Takigawa Hidehiko Takigawa 1*Yuji Urabe Yuji Urabe 1*Toshio Kuwai Toshio Kuwai 2*Fumio Shimamoto Fumio Shimamoto 3*Shiro Oka Shiro Oka 1*
  • 1 Department of Gastroenterology, Hiroshima University, Hiroshima, Japan
  • 2 Department of Gastrointestinal Endoscopy and Medicine, Hiroshima University, Hiroshima, Japan
  • 3 Department of Health Sciences, Hiroshima Cosmopolitan University, Hiroshima, Japan

The final, formatted version of the article will be published soon.

    Background: Additional surgery with lymph node (LN) dissection is recommended for pT1 colorectal carcinoma (CRC) resected by endoscopy, based on pathological risk factors for LN metastasis (LNM), according to guidelines by the Japanese Society for Cancer of the Colon and Rectum (JSCCR), National Comprehensive Cancer Network (NCCN), and European Society for Medical Oncology (ESMO).We retrospectively analyzed 560 consecutive patients with T1 CRC who underwent endoscopic resection alone (n=190) or initial or additional surgery with LN dissection (n=370) between 1992 and 2017 at Hiroshima University Hospital. Patients were classified into LNM lowand high-risk groups according to guidelines by the JSCCR, NCCN, and ESMO as follows. Patients without any specified pathological LNM risk factor were included in the LNM low-risk group, while the high-risk group comprised all other patients. We analyzed the LNM predictive ability of each guideline.The LNM high-risk rate, sensitivity, specificity, positive and negative predictive values, accuracy of LNM risk, and AUC for LNM predictive ability were 82%, 100%, 19%, 9%, 100%, 26% and 0.596 in the JSCCR guidelines; 52%, 98%, 52%, 15%, 99%, 56%, and 0.749 in the NCCN; and 54%, 98%, 50%, 15%, 99%, 54%, and 0.743 in the ESMO, respectively.The JSCCR guidelines could diagnose LNM in all cases but had the highest falsepositive rate. It is important to reduce unnecessary additional surgeries for pT1 CRCs after ER.

    Keywords: colorectal cancer, T1, guideline, lymph node metastasis, Endoscopic resection

    Received: 03 Aug 2024; Accepted: 04 Oct 2024.

    Copyright: © 2024 Tanino, Yamashita, Morimoto, Takehara, Yamamoto, Kamigaichi, Nishimura, Tanaka, Takigawa, Urabe, Kuwai, Shimamoto and Oka. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Ken Yamashita, Department of Gastroenterology, Hiroshima University, Hiroshima, Japan
    Shin Morimoto, Department of Gastroenterology, Hiroshima University, Hiroshima, Japan
    Yudai Takehara, Department of Gastroenterology, Hiroshima University, Hiroshima, Japan
    Noriko Yamamoto, Department of Gastroenterology, Hiroshima University, Hiroshima, Japan
    Yuki Kamigaichi, Department of Gastroenterology, Hiroshima University, Hiroshima, Japan
    Tomoyuki Nishimura, Department of Gastroenterology, Hiroshima University, Hiroshima, Japan
    Hidenori Tanaka, Department of Gastroenterology, Hiroshima University, Hiroshima, Japan
    Hidehiko Takigawa, Department of Gastroenterology, Hiroshima University, Hiroshima, Japan
    Yuji Urabe, Department of Gastroenterology, Hiroshima University, Hiroshima, Japan
    Toshio Kuwai, Department of Gastrointestinal Endoscopy and Medicine, Hiroshima University, Hiroshima, Japan
    Fumio Shimamoto, Department of Health Sciences, Hiroshima Cosmopolitan University, Hiroshima, Japan
    Shiro Oka, Department of Gastroenterology, Hiroshima University, Hiroshima, Japan

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