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Predictors for regional lymph node metastasis in T1 rectal cancer: a population-based SEER analysis

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Abstract

Background

Local resection of early-stage rectal cancer significantly reduces perioperative morbidity compared with radical resection. Identifying patients at risk of regional lymph node metastasis (LNM) is crucial for long-term survival after local resection.

Methods

Patients after oncological resection of T1 rectal cancer were identified in the Surveillance, Epidemiology, and End Results register 2004–2012. Potential predictors of LNM and its impact on cancer-specific survival were assessed in logistic and Cox regression with and without multivariable adjustment.

Results

In total, 1593 patients with radical resection of T1 rectal cancer and a minimum of 12 retrieved regional lymph nodes were identified. The overall LNM rate was 16.3 % (N = 260). A low risk of LNM was observed for small tumor size (P = 0.002), low tumor grade (P = 0.002) and higher age (P = 0.012) in multivariable analysis. The odds ratio for a tumor size exceeding 1.5 cm was 1.49 [95 % confidence interval (CI) 1.06–2.13], for G2 and G3/G4 carcinomas 1.69 (95 % CI 1.07–2.82) and 2.72 (95 % CI 1.50–5.03), and for 65- to 79-year-old and over 80-year-old patients 0.65 (95 % CI 0.43–0.96) and 0.39 (95 % CI 0.18–0.77), respectively. Five-year cancer-specific survival for patients with LNM was 90.0 % (95 % CI 85.3–95.0 %) and for patients without LNM 97.1 % (95 % CI 95.9–98.2 %, hazard ratio = 3.21, 95 % CI 1.82–5.69, P < 0.001).

Conclusions

In this population-based analysis, favorable cancer-specific survival rates were observed in nodal-negative and nodal-positive T1 rectal cancer patients after primary radical resection. The predictive value of tumor size, grading and age for LNM should be considered in medical decision making about local resection.

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Acknowledgments

The authors thank the National Cancer Institute for providing the Surveillance, Epidemiology, and End Results (SEER) data set.

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    Authors and Affiliations

    1. Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland

      Walter Brunner, Bernhard Widmann, Lukas Marti, Ignazio Tarantino, Bruno M. Schmied & Rene Warschkow

    2. Department of General, Abdominal and Transplant Surgery, University of Heidelberg, 69120, Heidelberg, Germany

      Ignazio Tarantino

    3. Institute of Medical Biometry and Informatics, University of Heidelberg, 69120, Heidelberg, Germany

      Rene Warschkow

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    1. Walter Brunner
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    Correspondence to Bernhard Widmann.

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    Drs. Walter Brunner, Bernhard Widmann, Lukas Marti, Ignazio Tarantino, Bruno M. Schmied and Rene Warschkow have no conflicts of interest or financial ties to disclose.

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    Walter Brunner and Bernhard Widmann have contributed equally to this work.

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    Brunner, W., Widmann, B., Marti, L. et al. Predictors for regional lymph node metastasis in T1 rectal cancer: a population-based SEER analysis. Surg Endosc 30, 4405–4415 (2016). https://doi.org/10.1007/s00464-016-4759-3

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