Nomogram as a novel predictive tool for lymph node metastasis in T1 colorectal cancer treated with endoscopic resection: a nationwide, multicenter study.

Humans Nomograms Lymphatic Metastasis Colorectal Neoplasms / surgery Neoplasm Invasiveness / pathology Colonic Neoplasms

Journal

Gastrointestinal endoscopy
ISSN: 1097-6779
Titre abrégé: Gastrointest Endosc
Pays: United States
ID NLM: 0010505

Informations de publication

Date de publication:
06 2023
Historique:
received: 05 09 2022
revised: 09 12 2022
accepted: 01 01 2023
medline: 22 5 2023
pubmed: 21 1 2023
entrez: 20 1 2023
Statut: ppublish

Résumé

Since 2009, the Japanese Society for Cancer of the Colon and Rectum guidelines have recommended that tumor budding and submucosal invasion depth, in addition to lymphovascular invasion and tumor grade, be included as risk factors for lymph node metastasis (LNM) in patients with T1 colorectal cancer (CRC). In this study, a novel nomogram was developed and validated by usirge-scale, real-world data, including the Japanese Society for Cancer of the Colon and Rectum risk factors, to accurately evaluate the risk of LNM in T1 CRC. Data from 4673 patients with T1 CRC treated at 27 high-volume institutions between 2009 and 2016 were analyzed for LNM risk. To prepare a nonrandom split sample, the total cohort was divided into development and validation cohorts. Pathologic findings were extracted from the medical records of each participating institution. The discrimination ability was measured by using the concordance index, and the variability in each prediction was evaluated by using calibration curves. Six independent risk factors for LNM, including submucosal invasion depth and tumor budding, were identified in the development cohort and entered into a nomogram. The concordance index was .784 for the clinical calculator in the development cohort and .790 in the validation cohort. The calibration curve approached the 45-degree diagonal in the validation cohort. This is the first nomogram to include submucosal invasion depth and tumor budding for use in routine pathologic diagnosis based on data from a nationwide multi-institutional study. This nomogram, developed with real-world data, should improve decision-making for an appropriate treatment strategy for T1 CRC.

Sections du résumé

BACKGROUND AND AIMS
Since 2009, the Japanese Society for Cancer of the Colon and Rectum guidelines have recommended that tumor budding and submucosal invasion depth, in addition to lymphovascular invasion and tumor grade, be included as risk factors for lymph node metastasis (LNM) in patients with T1 colorectal cancer (CRC). In this study, a novel nomogram was developed and validated by usirge-scale, real-world data, including the Japanese Society for Cancer of the Colon and Rectum risk factors, to accurately evaluate the risk of LNM in T1 CRC.
METHODS
Data from 4673 patients with T1 CRC treated at 27 high-volume institutions between 2009 and 2016 were analyzed for LNM risk. To prepare a nonrandom split sample, the total cohort was divided into development and validation cohorts. Pathologic findings were extracted from the medical records of each participating institution. The discrimination ability was measured by using the concordance index, and the variability in each prediction was evaluated by using calibration curves.
RESULTS
Six independent risk factors for LNM, including submucosal invasion depth and tumor budding, were identified in the development cohort and entered into a nomogram. The concordance index was .784 for the clinical calculator in the development cohort and .790 in the validation cohort. The calibration curve approached the 45-degree diagonal in the validation cohort.
CONCLUSIONS
This is the first nomogram to include submucosal invasion depth and tumor budding for use in routine pathologic diagnosis based on data from a nationwide multi-institutional study. This nomogram, developed with real-world data, should improve decision-making for an appropriate treatment strategy for T1 CRC.

Identifiants

DOI: 10.1016/j.gie.2023.01.022 PMID: 36669574
pubmed: 36669574
pii: S0016-5107(23)00026-3
doi: 10.1016/j.gie.2023.01.022
pii:
doi:

Types de publication

Multicenter Study Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1119-1128.e5

Informations de copyright

Copyright © 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Auteurs

Yoshiki Kajiwara (Y)

Department of Surgery, National Defense Medical College, Tokorozawa, Japan. Electronic address: ykaji@ndmc.ac.jp.

Shiro Oka (S)

Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.

Shinji Tanaka (S)

Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.

Takahiro Nakamura (T)

Laboratory for Mathematics, National Defense Medical College, Tokorozawa, Japan.

Shoichi Saito (S)

Department of Lower Gastrointestinal Medicine, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.

Yosuke Fukunaga (Y)

Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.

Manabu Takamatsu (M)

Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.

Hiroshi Kawachi (H)

Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.

Kinichi Hotta (K)

Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan.

Hiroaki Ikematsu (H)

Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan.

Motohiro Kojima (M)

Division of Pathology, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Kashiwa, Japan.

Yutaka Saito (Y)

Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.

Masayoshi Yamada (M)

Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.

Yukihide Kanemitsu (Y)

Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan.

Shigeki Sekine (S)

Pathology and Clinical Laboratory Division, National Cancer Center Hospital, Tokyo, Japan.

Shinji Nagata (S)

Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.

Kazutaka Yamada (K)

Coloproctology Center Takano Hospital, Kumamoto, Japan.

Nozomu Kobayashi (N)

Department of Gastroenterology, Tochigi Cancer Center, Utsunomiya, Japan.

Soichiro Ishihara (S)

Department of Surgical Oncology, University of Tokyo, Tokyo, Japan.

Yusuke Saitoh (Y)

Digestive Disease Center, Asahikawa City Hospital, Hokkaido, Japan.

Kenji Matsuda (K)

Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan.

Kazutomo Togashi (K)

Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan.

Koji Komori (K)

Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.

Megumi Ishiguro (M)

Medical Innovation Promotion Center, Tokyo Medical and Dental University, Tokyo, Japan.

Toshio Kuwai (T)

Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan.

Takashi Okuyama (T)

Department of Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan.

Akihiro Ohuchi (A)

Department of Gastroenterology, School of Medicine, Kurume University, Fukuoka, Japan.

Shinobu Ohnuma (S)

Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.

Kazuhiro Sakamoto (K)

Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan.

Tamotsu Sugai (T)

Department of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, Iwate, Japan.

Kenji Katsumata (K)

Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan.

Hiro-O Matsushita (HO)

Digestive Disease Center, Akita Red Cross Hospital, Akita, Japan.

Hiro-O Yamano (HO)

Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan.

Hirotsugu Eda (H)

Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.

Toshio Uraoka (T)

Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.

Naohiko Akimoto (N)

Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan.

Hirotoshi Kobayashi (H)

Department of Surgery, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan.

Yoichi Ajioka (Y)

Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Science, Niigata University, Niigata, Japan.

Kenichi Sugihara (K)

Tokyo Medical and Dental University, Tokyo, Japan.

Hideki Ueno (H)

Department of Surgery, National Defense Medical College, Tokorozawa, Japan.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Nomogram as a novel predictive tool for lymph...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Modèles statistiques › Nomogrammes › Nomogram as a novel predictive tool for lymph...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Processus néoplasiques › Métastase tumorale › Métastase lymphatique › Nomogram as a novel predictive tool for lymph...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies gastro-intestinales › Maladies intestinales › Maladies du rectum › Tumeurs colorectales › Nomogram as a novel predictive tool for lymph...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Processus néoplasiques › Invasion tumorale › Nomogram as a novel predictive tool for lymph...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies gastro-intestinales › Maladies intestinales › Tumeurs de l'intestin › Tumeurs du côlon › Nomogram as a novel predictive tool for lymph...