Does Tumor Location in Colon and Rectum Correlate With the Risk of Nodal Metastasis in T1 Colorectal Cancer?
Supakij Khomvilai*1, Pokala R. Kiran1, Madhusudhan R. Sanaka2, Ian C. Lavery1
1Colorectal Surgery, Digestive Disease Institute, Cleveland, OH; 2Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland, OH
Purpose : For T1 colorectal cancer resected endoscopically, the risk of lymph nodal involvement impacts further management. Whether this risk may vary depending upon the location in the colon and rectum has been poorly characterized. We evaluate the risk of lymph node metastasis in T1 colorectal cancer depending upon the location of the primary tumor and evaluate factors that may predict the presence of metastasis in each part of colon and rectum.Method : Data of all patients who underwent radical resection for T1 colorectal cancer from January 1997 - March 2010 were evaluated. Patient and tumor factors (location, grade, presence of lymphovascular invasion) associated with the finding of lymph nodal involvement for patients with a radical resection specimen were evaluated. Results : Of 150 patients (41% females, mean age 64 years and 59% males, mean age 65 years) undergoing radical resection for T1 colorectal cancer, 18 (12%) had nodal metastasis. The risk of nodal metastasis at individual tumor sites was 20.7% upper rectum, 18.2% lower rectum, 18.2% ascending colon, 12.5% sigmoid, 10.5% mid rectum, 4.3% cecum and 0% for hepatic flexure, transverse, splenic flexure and descending colon. Age of patients (P = 0.35 ), gender ( P = 0.82 ), size of lesion ( P = 0.58 ), tumor differentiation ( P = 0.33 ) and lymphovascular invasion ( P = 0.1 ) were not significantly associated with nodal metastasis.T1 rectal cancer had higher risk of nodal metastasis ( 16.9% ) compared to colon cancer ( 8.8% ) although this did not reach statistical significance ( P = 0.14, OR = 2.12). Conclusion : The risk of lymph node metastasis varies depending upon location of the T1 colorectal cancer. These findings support the incorporation of the location of the primary into the management algorhithm when faced with the decision whether to offer radical surgery or colonoscopic surveillance for patients with T1 cancers detected at polypectomy.
Risk factor associated with nodal metastasis for T1 Colorectal Cancer
| Variable | Overall N=150 | Lymph node positive (total = 18 (12%)) | P-value | OR (95% CI) | |
| Age (average) | 64.92 +/- 13.01 | 62.22 +/- 13.01 | 0.35 | 0.92 (0.76 ; 1.10) | |
| Age | < 65 | 69 (46.0%) | 10 (14.5%) | 0.39 | 0.65 (0.24,1.74) |
| > 65 | 81 (54.0%) | 8 (9.9%) | |||
| Gender | Female | 62 (41.3%) | 7 (11.3%) | 0.82 | 1.12 (0.41,3.08) |
| Male | 88 (58.7%) | 11 (12.5%) | |||
| TumorSite | Cecum | 23 (15.3%) | 1 (4.3%) | 0.78 | |
| Ascending | 11 (7.3%) | 2 (18.2%) | |||
| Hepatic Flexure | 6 (4.0%) | 0 (0%) | |||
| Transverse | 2 (1.3%) | 0 (0%) | |||
| Splenic Flexure | 3 (2.0%) | 0 (0%) | |||
| Descending | 6 (4.0%) | 0 (0%) | |||
| Sigmoid | 40 (26.7%) | 5 (12.5%) | |||
| UpperRectum | 29 (19.3%) | 6 (20.7%) | |||
| MidRectum | 19 (12.7%) | 2 (10.5%) | |||
| LowRectum | 11 (7.3%) | 2 (18.2%) | |||
| Tumor Differentiation | Well | 28 (18.7%) | 1 (3.6%) | 0.33 | |
| Moderate | 103 (68.7%) | 15 (14.6%) | |||
| Poorly | 19 (12.7%) | 2 (10.5%) | |||
| Lymphovascular invasion | Negative | 140 (93.3%) | 15 (10.7%) | 0.1 | 3.57 (0.83,15.30) |
| Postive | 10 (6.7%) | 3 (30.0%) | |||
| Size (average) | 2.43 +/- 1.88 | 2.66 +/- 1.74 | 0.58 | 1.07 (0.85 ; 1.35) | |
| Size | < 2 cm. | 78 (52.0%) | 7 (9.0%) | 0.24 | 1.83 (0.67,5.01) |
| > 2 cm. | 72 (48.0%) | 11 (15.3%) | |||
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