Risk of metastasis in pedunculated T1 Colorectal Cancer
Background & Aims
Most patients with pedunculated T1 colorectal tumors referred for surgery are not found to have lymph node metastases, and were therefore unnecessarily placed at risk for surgery-associated complications. The study on the development of the current model aimed to identify factors associated with need for surgery in patients with pedunculated T1 colorectal tumors.

Five histologic factors were identified that differentiated cases from controls: lymphovascular invasion, Haggitt level 4 invasion, muscularis mucosae type B (incompletely or completely disrupted), poorly differentiated clusters and tumor budding, which identified patients who required surgery with an area under the curve (AUC) value of 0.83 (95% CI, 0.76 – 0.90).

In a cohort-nested matched case–control study of 708 patients with pedunculated T1 colorectal carcinomas, a model based on histologic features of tumors that identifies patients who require surgery (due to high risk of metastasis) was developed with greater accuracy than previous models. This model might be used to identify patients most likely to benefit from adjuvant surgery.
Research authors: Yara Backes, Sjoerd G. Elias, John N. Groen, Matthijs P. Schwartz, Frank H.J. Wolfhagen, Joost M.J. Geesing, Frank ter Borg, Jeroen van Bergeijk, Bernard W.M. Spanjer, Wouter H. de Vos tot Nederveen Cappel, Koen Kessels, Cornelis A. Seldenrijk, Mihaela G. Raicu, Paul Drillenburg, Anya N. Milne, Marjon Kerkhof, Tom C.J. Seerden, Peter D. Siersema, Frank P. Vleggaar, G. Johan A. Offerhaus, Miangela M. Lacle, Leon M.G. Moons
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Predicted risk of metastasis in penduculated T1 CRC

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When using a clinically plausible predicted probability threshold of 4.0% or more, 67.5% of patients (478/708) were predicted to not need surgery. This threshold identified patients who required surgery with 83.8% sensitivity (95% CI, 68.0 – 93.8) and 70.3% specificity (95% CI, 60.9 – 78.6). 

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Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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