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Quénéhervé L, Pioche M, Jacques J. Curative criteria for endoscopic treatment of colorectal cancer. Best Pract Res Clin Gastroenterol 2024; 68:101883. [PMID: 38522881 DOI: 10.1016/j.bpg.2024.101883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/17/2024] [Indexed: 03/26/2024]
Abstract
As endoscopic treatment enables en bloc resection of T1 colorectal cancers, the risk of recurrence, often assimilated to the risk of lymph node metastases, must be assessed in order to offer patients an additional treatment if this risk is deemed significant. The curative criteria currently used by most guidelines are depth of invasion <1 mm, well or moderately differentiated tumour, absence of lympho-vascular invasion, absence of significant budding and tumour-free resection margins. However, these factors must be assessed by qualified pathologists, as they are difficult to evaluate. Moreover, the combination of these factors leads to unnecessary surgery in over 80 % of patients whose tumours are classified as high risk. Refinement of current criteria and research into new tumour and immunological markers are needed to better predict the actual risk of our patients.
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Affiliation(s)
| | - Mathieu Pioche
- Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France.
| | - Jérémie Jacques
- Department of Endoscopy and Gastroenterology, Centre Hospitalier Universitaire Dupuytren, Limoges, France.
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Koyama Y, Yamada M, Makiguchi ME, Sekiguchi M, Takamaru H, Sakamoto T, Kono S, Fukuzawa M, Sylvia Wu SY, Sugumaran A, Kawai T, Matsuda T, Itoi T, Saito Y. New scoring system to distinguish deep invasive submucosal and muscularis propria colorectal cancer during colonoscopy: a development and global multicenter external validation study (e-T2 Score). Gastrointest Endosc 2022; 96:321-329.e2. [PMID: 35271864 DOI: 10.1016/j.gie.2022.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 03/01/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Diagnostics to differentiate deep submucosal invasive (invasion depth ≥1000 μm [T1b]) colorectal cancer (CRC) from muscularis propria invasive (T2) CRC are limited. We aimed to establish and validate a scoring system that differentiates T1b from T2. METHODS A multicenter retrospective cross-validation study was performed. Four hundred sixty-one consecutive pathologically confirmed T1b or T2 CRCs were divided into the development (T1b, 222; T2, 189) and internal validation (T1b, 31; T2, 19) cohorts. Eight potential endoscopic findings were evaluated using the development cohort: loss of lobulation, deep depression, demarcated depressed area, protuberance within the depression, expanding appearance, fold convergency, erosion or white plaque, and Borrmann type 2 or 3 tumor. A scoring system that differentiates T1b from T2 was developed, and diagnostic performance was tested using the internal validation cohort by 8 endoscopists. External validation was conducted using 50 CRC images by 4 endoscopists from other institutions, including outside of Japan. RESULTS Multivariate analysis identified the following 5 independent predictive endoscopic findings of T2 CRC: deep depression (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.07-4.04), demarcated depressed area (OR, 4.40; 95% CI, 1.39-13.9), 4-fold convergency or more (OR, 3.41; 95% CI, 1.90-6.11), erosion or white plaque (OR, 8.28; 95% CI, 2.77-24.7), and Borrmann type 2 or 3 tumor (OR, 8.76; 95% CI, 3.58-21.5). The area under the receiver-operating characteristic curve (AUROC) was .90 (95% CI, .87-.93) in the development cohort, .80 (95% CI, .76-.85) in the internal validation, and .76 (95% CI, .69-.83) in the external validation. CONCLUSIONS We established and validated a new scoring system to differentiate T1b from T2 CRC using 5 simple endoscopic findings.
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Affiliation(s)
- Yohei Koyama
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Masayoshi Yamada
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Department of Genetic Medicine and Services, National Cancer Center Hospital, Tokyo, Japan
| | | | - Masau Sekiguchi
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Shin Kono
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Masakatsu Fukuzawa
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | | | | | - Takashi Kawai
- Department of Endoscopy, Tokyo Medical University Hospital, Tokyo, Japan
| | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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Taghiakbari M, Pohl H, Djinbachian R, Barkun A, Marques P, Bouin M, Deslandres E, Panzini B, Bouchard S, Weber A, von Renteln D. The location-based resect and discard strategy for diminutive colorectal polyps: a prospective clinical study. Endoscopy 2022; 54:354-363. [PMID: 34448185 DOI: 10.1055/a-1546-9169] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Clinical implementation of the resect-and-discard strategy has been difficult because optical diagnosis is highly operator dependent. This prospective study aimed to evaluate a resect-and-discard strategy that is not operator dependent. METHODS The study evaluated a resect-and-discard strategy that uses the anatomical polyp location to classify colonic polyps into non-neoplastic or low risk neoplastic. All rectosigmoid diminutive polyps were considered hyperplastic and all polyps located proximally to the sigmoid colon were considered neoplastic. Surveillance interval assignments based on these a priori assumptions were compared with those based on actual pathology results and on optical diagnosis. The primary outcome was ≥ 90 % agreement with pathology in surveillance interval assignment. RESULTS 1117 patients undergoing complete colonoscopy were included and 482 (43.1 %) had at least one diminutive polyp. Surveillance interval agreement between the location-based strategy and pathological findings using the 2020 US Multi-Society Task Force guideline was 97.0 % (95 % confidence interval [CI] 0.96-0.98), surpassing the ≥ 90 % benchmark. Optical diagnoses using the NICE and Sano classifications reached 89.1 % and 90.01 % agreement, respectively (P < 0.001), and were inferior to the location-based strategy. The location-based resect-and-discard strategy allowed a 69.7 % (95 %CI 0.67-0.72) reduction in pathology examinations compared with 55.3 % (95 %CI 0.52-0.58; NICE and Sano) and 41.9 % (95 %CI 0.39-0.45; WASP) with optical diagnosis. CONCLUSION The location-based resect-and-discard strategy achieved very high surveillance interval agreement with pathology-based surveillance interval assignment, surpassing the ≥ 90 % benchmark and outperforming optical diagnosis in surveillance interval agreement and the number of pathology examinations avoided.
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Affiliation(s)
- Mahsa Taghiakbari
- University of Montréal, Montréal, Quebec, Canada.,University of Montréal Hospital Research Center (CRCHUM), Montréal, Quebec, Canada
| | - Heiko Pohl
- Department of Veterans Affairs Medical Center, White River Junction, Vermont, USA.,Dartmouth Geisel School of Medicine and The Dartmouth Institute, Hanover, New Hampshire, USA
| | - Roupen Djinbachian
- University of Montréal Hospital Research Center (CRCHUM), Montréal, Quebec, Canada.,Division of Internal Medicine, University of Montréal Hospital Center (CHUM), Montréal, Quebec, Canada
| | - Alan Barkun
- Division of Gastroenterology, McGill University Health Center, McGill University, Montréal, Quebec, Canada
| | - Paola Marques
- Faculty of Medicine, Bahia State University, Salvador, Bahia, Brazil
| | - Mickael Bouin
- University of Montréal Hospital Research Center (CRCHUM), Montréal, Quebec, Canada.,Division of Gastroenterology, University of Montréal Hospital Center (CHUM), Montréal, Quebec, Canada
| | - Eric Deslandres
- Division of Gastroenterology, University of Montréal Hospital Center (CHUM), Montréal, Quebec, Canada
| | - Benoit Panzini
- Division of Gastroenterology, University of Montréal Hospital Center (CHUM), Montréal, Quebec, Canada
| | - Simon Bouchard
- University of Montréal Hospital Research Center (CRCHUM), Montréal, Quebec, Canada.,Division of Gastroenterology, University of Montréal Hospital Center (CHUM), Montréal, Quebec, Canada
| | - Audrey Weber
- University of Montréal Hospital Research Center (CRCHUM), Montréal, Quebec, Canada.,Division of Gastroenterology, University of Montréal Hospital Center (CHUM), Montréal, Quebec, Canada
| | - Daniel von Renteln
- University of Montréal Hospital Research Center (CRCHUM), Montréal, Quebec, Canada.,Division of Gastroenterology, University of Montréal Hospital Center (CHUM), Montréal, Quebec, Canada
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Bordet M, Bretagne JF, Piette C, Rousseau C, Grainville T, Cosson M, Lièvre A. Surgical rather than endoscopic resection of early-stage colorectal cancers promotes excessive imaging surveillance. Clin Res Hepatol Gastroenterol 2021; 45:101735. [PMID: 34146722 DOI: 10.1016/j.clinre.2021.101735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/20/2021] [Accepted: 05/28/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Imaging surveillance after curative resection of colorectal cancer (CRC) is debated, particularly in cases of early-stage CRC. The aim of this study was to retrospectively analyze whether and how patients with screened stage 0 and stage 1 CRC were monitored by imaging. METHODS A cohort of patients with stage 0 (intramucosal) or stage 1 (T1N0) CRC detected from 2003 to 2015 through the French national screening programme was included. All imaging findings were recorded. Statistical analyses were performed for the entire cohort (n = 450) and separately for the two groups (stage 0 n = 268, stage 1 n = 182). Factors associated with imaging surveillance, including the patient's referring gastroenterologist, were determined by logistic regression. RESULTS A total of 450 patients were followed up for 6.6 ± 3.9 years. Imaging surveillance was performed for 159 (35.3%), more often for those with stage 1 (66.5%) than stage 0 (14.2%) tumours (p < 0.0001). Within the stage 1 group, 17 of the 47 patients (36.2%) treated by local (endoscopic or surgical transanal) resection alone were followed up by imaging monitoring. Factors significantly associated with surveillance in the entire cohort were the gastroenterologist assigned to the patient (p < 0.0001) and surgical vs endoscopic resection (OR = 39.0, p < 0.0001). The histological risk of lymph node metastasis was not significantly associated with imaging monitoring for stage 1 patients. Of the 5 patients who developed distant metastasis during follow-up, one was diagnosed through imaging surveillance. CONCLUSION This study demonstrates excessive imaging surveillance for early-stage cancers. The use of surgical over endoscopic tumour resection could promote unnecessary surveillance.
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Affiliation(s)
- Martin Bordet
- Department of Gastroenterology, University Hospital, 35033 Rennes, France
| | | | - Christine Piette
- ADECI 35 (Association pour le Dépistage des Cancers en Ille-et-Vilaine), 35040 Rennes, France
| | - Chloé Rousseau
- Department of Biostatistics, University Hospital, 35033 Rennes, France
| | - Thomas Grainville
- Department of Gastroenterology, University Hospital, 35033 Rennes, France
| | - Mathilde Cosson
- ADECI 35 (Association pour le Dépistage des Cancers en Ille-et-Vilaine), 35040 Rennes, France
| | - Astrid Lièvre
- Department of Gastroenterology, University Hospital, 35033 Rennes, France; Rennes 1 University, 35000 Rennes, France; ADECI 35 (Association pour le Dépistage des Cancers en Ille-et-Vilaine), 35040 Rennes, France; COSS (Chemistry Oncogenesis Stress Signaling), UMR_S 1242, Rennes, France
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Significant decrease in interval colorectal cancer incidence after implementing immunochemical testing in a multiple-round guaiac-based screening programme. Br J Cancer 2021; 125:1494-1502. [PMID: 34511603 DOI: 10.1038/s41416-021-01546-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/04/2021] [Accepted: 09/03/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND AIMS We aimed to evaluate the effects of switching to faecal immunochemical testing (FIT) on the cumulative 2-year incidence rate of interval cancers, interval cancer rate and test sensitivity within a mature population-based colorectal cancer screening programme consisting of six rounds of biennial guaiac faecal occult blood testing (gFOBT). METHODS The FIT results were compared with those of gFOBT used in each of the previous two rounds. For the three rounds analysed, 279,041 tests were performed by 156,186 individuals. Logistic regression analysis was used to determine interval cancer risk factors (Poisson regression) and to compare the sensitivity of FIT to gFOBT. RESULTS There were 612 cases of screen-detected cancers and 209 cases of interval cancers. The sex- and age-adjusted cumulative 2-year incidence rates of interval cancers were 55.7 (95% CI, 45.3-68.5), 42.4 (95% CI, 32.6-55.2) and 15.8 (95% CI, 10.9-22.8) per 100,000 person-years after the last two rounds of gFOBT and FIT, respectively. The FIT/gFOBT incidence rate ratio was 0.38 [95% CI, 0.27-0.54] (P < 0.001). Sex- and age-adjusted sensitivity was significantly higher with FIT than with gFOBT (OR = 6.70 [95% CI, 4.48-10.01], P < 0.0001). CONCLUSIONS This population-based study revealed a dramatic decrease in the cumulative incidence rates of interval cancers after switching from gFOBT to FIT. These data provide an additional incentive for countries still using gFOBT to switch to FIT.
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