6533b826fe1ef96bd1284804

RESEARCH PRODUCT

Tumor budding as a risk factor for nodal metastasis in pT1 colorectal cancers: a meta-analysis

Rocco CappellessoFranca De LazzariPierluigi PilatiE. Rosa-rizzottoClaudio LuchiniNicola VeroneseMarcello Lo MeleMarco SolmiMassimo RuggeE. GuidoStefano RealdonFabio FarinatiMatteo Fassan

subject

Oncologymedicine.medical_specialtyColorectal cancerBiopsyTumor buddingAdenocarcinomaRisk AssessmentPathology and Forensic MedicineColorectal cancer; Lymph node metastasis; Meta-analysis; Sprouting; Tumor buddingColorectal cancer; Lymph node metastasis; Meta-analysis; Sprouting; Tumor budding; Adenocarcinoma; Biopsy; Colorectal Neoplasms; Humans; Lymph Nodes; Lymphatic Metastasis; Neoplasm Invasiveness; Neoplasm Staging; Odds Ratio; Predictive Value of Tests; Risk Assessment; Risk Factors; Cell MovementLymph node metastasi03 medical and health sciences0302 clinical medicineTumor buddingPredictive Value of TestsRisk FactorsCell MovementTumor budding.Internal medicineBiopsymedicineOdds RatioHumansMeta-analysiNeoplasm InvasivenessRisk factorNeoplasm StagingLymph node metastasismedicine.diagnostic_testbusiness.industryCancerOdds ratiomedicine.diseaseColorectal cancerSurgeryMeta-analysis030220 oncology & carcinogenesisPredictive value of testsLymphatic MetastasisAdenocarcinoma030211 gastroenterology & hepatologyLymph NodesbusinessColorectal NeoplasmsSprouting

description

Worldwide, colorectal cancer (CRC) screening programs have significantly increased the detection of submucosal (pT1) adenocarcinoma. Completion surgery may be indicated after endoscopic excision of these potentially metastasizing early cancers. However, the postsurgical prevalence of nodal implants does not exceed 15%, leading to questions concerning the clinical appropriateness of any post–endoscopy surgery. Eastern scientific societies (Japanese Society for Cancer of the Colon-Rectum, in particular) include tumor budding (TB), defined as the presence of isolated single cancer cells or clusters of fewer than 5 cancer cells at the tumor invasive front, among the variables that must be included in histologic reports. In Western countries, however, no authoritative endorsements recommend the inclusion of TB in the histology report because of the heterogeneity of definitions and measurement methods as well as its apparent poor reproducibility. To assess the prognostic value of TB in pT1 CRCs, this meta-analysis evaluated 41 studies involving a total of 10 137 patients. We observed a strong association between the presence of TB and risk of nodal metastasis in pT1 CRC. In comparing TB-positive (684/2401; 28.5%) versus TB-negative (557/7736; 7.2%) patients, the prevalence of nodal disease resulted in an odds ratio value of 6.44 (95% confidence interval, 5.26-7.87; P < .0001; I2 = 30%). This increased risk of regional nodal metastasis was further confirmed after accounting for potential confounders. These results support the priority of histologically reporting TB in any endoscopically removed pT1 CRC to direct more appropriate patient management. © 2017 Elsevier Inc.

10.1016/j.humpath.2017.04.013http://hdl.handle.net/11562/972980