title: A clinical model for predicting lymph node metastasis in submucosal invasive (T1) colorectal cancer.
abstract: BACKGROUND
  No single histopathological feature of submucosal invasive colorectal cancer (T1-CRC) can reliably predict the risk for lymph node metastasis (LNM).
  
  
  OBJECTIVE
  The purpose of the study was to develop a prediction model of LNM in T1-CRC.
  
  
  METHODS
  Ninety-seven surgically resected T1-CRC at our institution were retrospectively evaluated. Morphology, localization, grading, mode of growth, presence of background adenoma, lymphoid infiltration, angiolymphatic invasion, budding, and depth of invasion were assessed. Mortality and morbidity related to surgery were also evaluated. Benefit-risk balance was assessed according to the presence of severe complications and to the presence of LNM.
  
  
  RESULTS
  Fourteen cases had LNM (14%). Eight patients (8%) presented severe surgical complications and there were two deaths (2 %). Infiltrative growth pattern (OR 31.91, 95% CI 2.37-428.36; p = 0.009) and the absence of lymphoid infiltrate (OR 28.75; 95% CI 2.13-388.37; p = 0.011) were the only variables independently associated with LNM in the multivariate analysis. Both variables were included in the prediction model together with sessile morphology (OR 4.88; 95% CI 0.81-29.3; p = 0.083) and poorly differentiated carcinoma (OR 11.77; 95% CI 0.77-179.83; p = 0.076). A 0-100 score was developed (infiltrative growth pattern: no = 0, yes = 33; lymphoid infiltrate: no = 29, yes = 0; sessile morphology: no = 0, yes = 15; poorly differentiated: no = 0, yes = 23). Cutoff point to indicate additional surgery was set in 35 points (i.e., 10% risk LNM). Discrimination of the prediction model was excellent (AUC 0.90; 95% CI 0.81-0.99).
  
  
  CONCLUSIONS
  Combined evaluation of infiltrative growth pattern, lymphoid infiltration, poorly differentiated carcinoma, and sessile appearance showed good performance for discriminating T1-CRC patients with LNM. The benefit-risk balance was in favor of surgery when at least two of these criteria were present.
authors.affiliation: Gastroenterology Department, University Hospital of Santiago de Compostela, c/Choupana s/n, 15706, Santiago de Compostela, Spain, fmacgar@yahoo.es.
authors.forename: Fernando
authors.initials: F
authors.lastname: Macias-Garcia
authors.forename: Catuxa
authors.initials: C
authors.lastname: Celeiro-Muñoz
authors.forename: Lucia
authors.initials: L
authors.lastname: Lesquereux-Martinez
authors.forename: Francisco
authors.initials: F
authors.lastname: Gude-Sampedro
authors.forename: Laura
authors.initials: L
authors.lastname: Uribarri-Gonzalez
authors.forename: Ihab
authors.initials: I
authors.lastname: Abdulkader
authors.forename: Ana
authors.initials: A
authors.lastname: Alvarez-Castro
authors.forename: J Enrique
authors.initials: JE
authors.lastname: Dominguez-Muñoz
mesh_terms: D000236:Adenoma / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D016015:Logistic Models; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011183:Postoperative Complications