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Clin Gastroenterol Hepatol. 2019 May;17(6):1112-1120.e1. doi: 10.1016/j.cgh.2018.08.041. Epub 2018 Aug 18.

Pedunculated Morphology of T1 Colorectal Tumors Associates With Reduced Risk of Adverse Outcome.

Author information

1
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands.
2
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
3
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
4
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Critical Care Medicine, Vrije Universiteit University Medical Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
5
Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
6
Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands.
7
Department of Gastroenterology and Hepatology, Sint Jansdal Hospital, Harderwijk, The Netherlands.
8
Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, The Netherlands.
9
Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands.
10
Department of Gastroenterology and Hepatology, Isala Hospital, Zwolle, The Netherlands.
11
Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands.
12
Department of Gastroenterology and Hepatology, Diakonessenhuis Hospital, Utrecht, The Netherlands.
13
Department of Gastroenterology and Hepatology, Groene Hart Hospital, Gouda, The Netherlands.
14
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Gastroenterology and Hepatology, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands.
15
Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden University, Leiden, The Netherlands.
16
Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands.
17
Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
18
Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands.
19
Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, The Netherlands.
20
Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, Den Bosch, The Netherlands.
21
Department of Gastroenterology and Hepatology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
22
Department of Gastroenterology and Hepatology, Bernhoven Hospital, Uden, The Netherlands.
23
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. Electronic address: l.m.g.moons@umcutrecht.nl.

Abstract

BACKGROUND & AIMS:

Risk stratification for adverse events, such as metastasis to lymph nodes, is based only on histologic features of tumors. We aimed to compare adverse outcomes of pedunculated vs nonpedunculated T1 colorectal cancers (CRC).

METHODS:

We performed a retrospective study of 1656 patients diagnosed with T1CRC from 2000 through 2014 at 14 hospitals in The Netherlands. The median follow-up time of patients was 42.5 months (interquartile range, 18.5-77.5 mo). We evaluated the association between tumor morphology and the primary composite end point, adverse outcome, adjusted for clinical variables, histologic variables, resection margins, and treatment approach. Adverse outcome was defined as metastasis to lymph nodes, distant metastases, local recurrence, or residual tissue. Secondary end points were tumor metastasis, recurrence, and incomplete resection.

RESULTS:

Adverse outcome occurred in 67 of 723 patients (9.3%) with pedunculated T1CRCs vs 155 of 933 patients (16.6%) with nonpedunculated T1CRCs. Pedunculated morphology was independently associated with decreased risk of adverse outcome (adjusted odds ratio [OR], 0.59; 95% CI, 0.42-0.83; P = .003). Metastasis, incomplete resection, and recurrence were observed in 5.8%, 4.6%, and 3.9% of pedunculated T1CRCs vs 10.6%, 8.0%, and 6.6% of nonpedunculated T1CRCs, respectively. Pedunculated morphology was independently associated with a reduced risk of metastasis (adjusted OR, 0.62; 95% CI, 0.41-0.94; P = .03), incomplete resection (adjusted OR, 0.57; 95% CI, 0.36-0.91; P = .02), and recurrence (adjusted hazard ratio, 0.52; 95% CI, 0.32-0.85; P = .009). Metastasis, incomplete resection, and recurrence did not differ significantly between low-risk pedunculated vs nonpedunculated T1CRCs (0.8% vs 2.9%, P = .38; 1.5% vs 0%, P = .99; 1.5% vs 0%; P = .99). However, incomplete resection and recurrence were significantly lower for high-risk pedunculated vs nonpedunculated T1CRCs (6.5% vs 12.5%; P = .007; 4.4% vs 8.6%; P = .03).

CONCLUSIONS:

In a retrospective study of patients with T1CRC, we found pedunculated morphology to be associated independently with a decreased risk of adverse outcome in a T1CRC population at high risk of adverse outcome. Incorporating morphologic features of tumors in risk assessment could help predict outcomes of patients with T1CRC and help identify the best candidates for surgery.

KEYWORDS:

Colon Cancer; Colonoscopy; Endoscopic Mucosal Resection; Prognostic Factor

PMID:
30130623
DOI:
10.1016/j.cgh.2018.08.041

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