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

被引：40

作者：

Kajiwara, Yoshiki ^{[1
,37
]}

Oka, Shiro ^{[3
]}

Tanaka, Shinji ^{[3
]}

Nakamura, Takahiro ^{[2
]}

Saito, Shoichi ^{[4
]}

Fukunaga, Yosuke ^{[5
]}

Takamatsu, Manabu ^{[6
]}

Kawachi, Hiroshi ^{[6
]}

Hotta, Kinichi ^{[7
]}

Ikematsu, Hiroaki ^{[8
]}

Kojima, Motohiro ^{[9
]}

Saito, Yutaka ^{[10
]}

Yamada, Masayoshi ^{[10
]}

Kanemitsu, Yukihide ^{[11
]}

Sekine, Shigeki ^{[12
]}

Nagata, Shinji ^{[13
]}

Yamada, Kazutaka ^{[14
]}

Kobayashi, Nozomu ^{[15
]}

Ishihara, Soichiro ^{[16
]}

Saitoh, Yusuke ^{[17
]}

Matsuda, Kenji ^{[18
]}

Togashi, Kazutomo ^{[19
]}

Komori, Koji ^{[20
]}

Ishiguro, Megumi ^{[21
]}

Kuwai, Toshio ^{[22
]}

Okuyama, Takashi ^{[23
]}

Ohuchi, Akihiro ^{[24
]}

Ohnuma, Shinobu ^{[25
]}

Sakamoto, Kazuhiro ^{[26
]}

Sugai, Tamotsu ^{[27
]}

Katsumata, Kenji ^{[28
]}

Matsushita, Hiro-o ^{[29
]}

Yamano, Hiro-o ^{[30
]}

Eda, Hirotsugu ^{[31
]}

Uraoka, Toshio ^{[32
]}

Akimoto, Naohiko ^{[33
]}

Kobayashi, Hirotoshi ^{[34
]}

Ajioka, Yoichi ^{[35
]}

Sugihara, Kenichi ^{[36
]}

Ueno, Hideki ^{[1
]}

机构：

[1] Natl Def Med Coll, Dept Surg, Tokorozawa, Japan

[2] Natl Def Med Coll, Lab Math, Tokorozawa, Japan

[3] Hiroshima Univ Hosp, Dept Endoscopy, Hiroshima, Japan

[4] Japanese Fdn Canc Res, Canc Inst Hosp, Dept Lower Gastrointestinal Med, Tokyo, Japan

[5] Japanese Fdn Canc Res, Canc Inst Hosp, Dept Gastroenterol Surg, Tokyo, Japan

[6] Canc Inst Hosp, Japanese Fdn Canc Res, Dept Pathol, Tokyo, Japan

[7] Shizuoka Canc Ctr, Div Endoscopy, Shizuoka, Japan

[8] Natl Canc Ctr Hosp East, Dept Gastroenterol & Endoscopy, Kashiwa, Japan

[9] Natl Canc Ctr, Exploratory Oncol Res & Clin Trial Ctr, Div Pathol, Kashiwa, Japan

[10] Natl Canc Ctr, Endoscopy Div, Tokyo, Japan

[11] Natl Canc Ctr, Dept Colorectal Surg, Tokyo, Japan

[12] Natl Canc Ctr, Pathol & Clin Lab Div, Tokyo, Japan

[13] Hiroshima City Asa Citizens Hosp, Dept Gastroenterol, Hiroshima, Japan

[14] Takano Hosp, Coloproctol Ctr, Kumamoto, Japan

[15] Tochigi Canc Ctr, Dept Gastroenterol, Utsunomiya, Japan

[16] Univ Tokyo, Dept Surg Oncol, Tokyo, Japan

[17] Asahikawa City Hosp, Digest Dis Ctr, Hokkaido, Japan

[18] Wakayama Med Univ, Sch Med, Dept Surg 2, Wakayama, Japan

[19] Fukushima Med Univ, Aizu Med Ctr, Dept Coloproctol, Fukushima, Japan

[20] Aichi Canc Ctr Hosp, Dept Gastroenterol Surg, Nagoya, Japan

[21] Tokyo Med & Dent Univ, Med Innovat Promot Ctr, Tokyo, Japan

[22] Natl Hosp Org Kure Med Ctr, Chugoku Canc Ctr, Dept Gastroenterol, Kure, Japan

[23] Dokkyo Med Univ, Saitama Med Ctr, Dept Surg, Saitama, Japan

[24] Kurume Univ, Sch Med, Dept Gastroenterol, Fukuoka, Japan

[25] Tohoku Univ, Grad Sch Med, Dept Surg, Sendai, Japan

[26] Juntendo Univ, Fac Med, Dept Coloproctol Surg, Tokyo, Japan

[27] Iwate Med Univ, Sch Med, Dept Mol Diagnost Pathol, Morioka, Iwate, Japan

[28] Tokyo Med Univ, Dept Gastrointestinal & Pediat Surg, Tokyo, Japan

[29] Akita Red Cross Hosp, Digest Dis Ctr, Akita, Japan

[30] Sapporo Med Univ, Sch Med, Dept Gastroenterol & Hepatol, Sapporo, Japan

[31] Hyogo Coll Med, Dept Internal Med, Nishinomiya, Hyogo, Japan

[32] Natl Hosp Org Tokyo Med Ctr, Dept Gastroenterol, Tokyo, Japan

[33] Nippon Med Sch, Grad Sch Med, Dept Gastroenterol, Tokyo, Japan

[34] Tokyo Metropolitan Hiroo Gen Hosp, Dept Surg, Tokyo, Japan

[35] Niigata Univ, Grad Sch Med & Dent Sci, Div Mol & Diagnost Pathol, Niigata, Japan

[36] Tokyo Med & Dent Univ, Tokyo, Japan

[37] Natl Def Med Coll, Dept Surg, 3-2 Namiki, Saitama 3598513, Japan

来源：

GASTROINTESTINAL ENDOSCOPY | 2023年 / 97卷 / 06期

关键词：

LONG-TERM OUTCOMES; JAPANESE SOCIETY; SUBMUCOSAL INVASION; RISK-FACTORS; COLON; CARCINOMA; GUIDELINES; PROGNOSIS; DIAGNOSIS; DEPTH;

D O I：

10.1016/j.gie.2023.01.022

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

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 institu-tion. The discrimination ability was measured by using the concordance index, and the variability in each predic-tion 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 clin-ical 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, devel-oped with real-world data, should improve decision-making for an appropriate treatment strategy for T1 CRC.

引用

页码：1119 / 1128.e5

页数：15

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