title: Condition of muscularis mucosae is a risk factor for lymph node metastasis in T1 colorectal carcinoma.
abstract: BACKGROUND
  The Japanese Society for Cancer of the Colon and Rectum Guidelines for the Treatment of Colorectal Cancer 2010 state that curable T1 colorectal carcinoma (CRC) after endoscopic resection shows favorable histologic grade, absence of vessel involvement, submucosal invasion depth of <1,000 μm, and low-grade tumor budding.
  
  
  METHODS
  We evaluated 322 consecutive T1 CRCs with LN dissection between January 1993 and March 2012. According to the muscularis mucosae condition, CRCs were classified into three groups: type A, clearly identified; type B, incompletely disrupted with deformity; or type C, completely disrupted. We examined the relationship between the muscularis mucosae condition, clinicopathological findings, and lymph node (LN) metastasis.
  
  
  RESULTS
  The overall incidence of LN metastasis was 11.8 % (38/322): 0 % (0/46) for the type A group, 7.2 % (7/97) for the type B group, and 17.3 % (31/179) for the type C group. In univariate analysis of type B and C groups, unfavorable histologic grade, submucosal invasion of ≥1,000 μm, positive lymphatic invasion, high-grade tumor budding, and the type C group were associated with a significantly higher incidence of LN metastasis. In multivariate analysis, high-grade tumor budding (P < 0.001, odds ratio [OR] = 4.86), unfavorable histologic grade (P = 0.026, OR = 4.83), positive lymphatic invasion (P < 0.001, OR = 4.17), and the type C group (P = 0.012, OR = 3.38) were significantly associated with LN metastasis. The type C group showed a high incidence of moderate/severe lymphatic invasion.
  
  
  CONCLUSIONS
  The condition of the muscularis mucosae was an indicator of LN metastasis in T1 CRC.
authors.affiliation: Department of Gastroenterology and Metabolism, Graduate School of Biochemical Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Nakadoi
authors.forename: Shiro
authors.initials: S
authors.lastname: Oka
authors.forename: Shinji
authors.initials: S
authors.lastname: Tanaka
authors.forename: Nana
authors.initials: N
authors.lastname: Hayashi
authors.forename: Motomi
authors.initials: M
authors.lastname: Terasaki
authors.forename: Koji
authors.initials: K
authors.lastname: Arihiro
authors.forename: Fumio
authors.initials: F
authors.lastname: Shimamoto
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors