☆ 4.6 Review

Endoscopic Treatment of T1 Colorectal Cancer

CANCERS (2023)

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

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Summary: A novel nomogram was developed and validated based on a large-scale, real-world dataset to accurately evaluate the risk of lymph node metastasis in T1 colorectal cancer. Six independent risk factors, including submucosal invasion depth and tumor budding, were identified and incorporated into the nomogram. The nomogram demonstrated good predictive performance in both the development and validation cohorts. This nomogram, developed using real-world data, can aid in decision-making for an appropriate treatment strategy for T1 colorectal cancer.

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Summary: According to current guidelines, a large number of T1 CRC patients undergo unnecessary radical operations due to the lack of accurate biomarkers for identifying those with lymph node metastasis (LNM). This study found that a panel of exosomal miRNAs can predict LNM in T1 CRC patients with high accuracy, and a risk-stratification model including pathological features further improves the specificity.

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A proposal for grading the risk of lymph node metastasis after endoscopic resection of T1 colorectal cancer

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Summary: Currently, for patients with early colorectal cancer, additional surgery will be considered if they have any risk factor of lymph node metastasis (LNM) after endoscopic resection (ER), regardless of the degree of LNM risk; however, most patients have no LNM. This study aimed to further classify these patients based on LNM risk.

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Lymphovascular Infiltration, Not Depth of Invasion, is the Critical Risk Factor of Metastases in Early Colorectal Cancer Retrospective Population-based Cohort Study on Prospectively Collected Data, Including Validation

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The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colon Cancer

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Tumor Location as a Prognostic Factor in T1 Colorectal Cancer

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Summary: The incidence of T1 colorectal cancer is expected to rise due to the prevalence of colorectal cancer screening and progress in endoscopic treatment. Besides the known risk factors such as lymphovascular invasion, tumor differentiation, and depth of invasion, tumor location may also play a role in lymph node metastasis and recurrence. Therefore, treatment decisions for T1 colorectal cancer should take these factors into consideration.

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Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2022

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Summary: This guideline provides recommendations for the evaluation and treatment of superficial gastrointestinal lesions. It suggests that experienced endoscopists should use high definition white-light and chromoendoscopy for evaluation and recommends endoscopic submucosal dissection for most lesions. Different treatment approaches are suggested for specific situations. The guideline also provides recommendations for post-resection surveillance and treatment.

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Risk of recurrence after endoscopic resection of nonpedunculated T1 colorectal cancer

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Deep Submucosal Invasion Is Not an Independent Risk Factor for Lymph Node Metastasis in T1 Colorectal Cancer: A Meta-Analysis

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Summary: The meta-analysis shows that deep submucosal invasion (DSI) is not an independent predictor for lymph node metastasis (LNM) and should not be considered as the sole indicator for colorectal cancer surgery.

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Artificial intelligence predicts lymph node metastasis or risk of lymph node metastasis in T1 colorectal cancer

Kenta Kasahara et al.

Summary: This study used artificial intelligence to analyze biopsy specimens of T1 CRC and created a risk model for lymph node metastasis. The results showed that the model could improve the accuracy of preoperative diagnosis.

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Utility of artificial intelligence with deep learning of hematoxylin and eosin-stained whole slide images to predict lymph node metastasis in T1 colorectal cancer using endoscopically resected specimens; prediction of lymph node metastasis in T1 colorectal cancer

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Summary: This study demonstrates the potential of AI trained with DL of H&E-stained WSIs to predict LNM in T1 CRC using only endoscopically resected specimens with conventional histologic risk factors.

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Expected value of artificial intelligence in gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

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Lymph node metastasis in T1 colorectal cancer with the only high-risk histology of submucosal invasion depth ≥ 1000 μm

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Summary: The purpose of this study was to investigate the incidence of lymph node metastasis (LNM) and factors associated with LNM in T1 colorectal cancer (CRC) with high-risk histology characterized by T1b only. The study found that the incidence of LNM was low in patients with low-risk T1b, and the predominant histological type of moderately differentiated adenocarcinoma was independently associated with LNM in this group.

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Artificial Intelligence System to Determine Risk of T1 Colorectal Cancer Metastasis to Lymph Node

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Summary: By using an artificial intelligence model, it is possible to more accurately identify the risk of lymph node metastasis in patients with T1 colorectal cancer, thus reducing unnecessary surgical resections.

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Summary: The study found that 10.6% of T1 colorectal cancer patients had a risk of lymph-node metastasis, with younger age, female sex, Asian or African-American ethnicity, poor tumor differentiation, and tumor site outside the rectum being associated with a higher risk. Patients with rectal cancer had the lowest risk of lymph-node metastasis.

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