Risk of lymph node metastasis in T1 colorectal cancer with isolated deep submucosal invasion: a multicenter European study

Background Advances in colorectal cancer (CRC) screening and endoscopic techniques have led to increased detection of T1 CRC. Patient management relies on histopathological criteria predicting lymph node metastasis (LNM), including submucosal invasion depth (SID) >1000 µm. However, the independent prognostic value of isolated deep invasion remains unclear. Methods We performed a retrospective multicenter study of patients treated at 18 European centers between 2009 and 2022. Patients with T1 CRC endoscopically resected en bloc and with isolated SID >1000 µm (without other high-risk features) were included. Two groups were analyzed: patients who underwent additional surgery and those who were followed with surveillance. Rates of LNM (surgery group) and recurrence (local and distant; surveillance group) were assessed. Exploratory multivariable analyses were performed to evaluate clinicopathological factors associated with LNM. Results Among 179 included patients (124 surgery, 55 surveillance), LNM was found in 16/124 surgical specimens (12.9%; 95%CI 7.7-20.4) and recurrence occurred in 2/55 patients undergoing surveillance (3.6%; 95%CI 0.4-12.6). LNM occurred in 1/50 patients (2.0%) with SID <2000 µm and in 15/74 patients (20.3%) with SID ≥2000 µm. Multivariable analysis revealed SID ≥2000 µm (odds ratio [OR] 3.59; 95%CI 1.14-13.71) and colonic (vs. rectal) tumor location (OR 3.63; 95%CI 1.07-16.77) as factors associated with LNM. Conclusion Isolated deep submucosal invasion in T1 CRC was associated with a non-negligible rate of LNM in this real-world cohort. In exploratory analyses, SID ≥2000 µm was associated with LNM.

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Journal
Endoscopy
Published
2026-08-21
DOI
https://doi.org/10.1055/a-2925-6629
Primary Topic
Colorectal Cancer Surgical Treatments
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article
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article

Risk of lymph node metastasis in T1 colorectal cancer with isolated deep submucosal invasion: a multicenter European study

Elena De Cristofaro, Eukene Rojo, Félix Corre, Gabriel Rahmi et al.
Endoscopy
Colorectal Cancer Surgical Treatments
article

Risk of lymph node metastasis in T1 colorectal cancer with isolated deep submucosal invasion: a multicenter European study

Elena De Cristofaro, Eukene Rojo, Félix Corre, Gabriel Rahmi, David Karsenti, Nicolas Etchepare, Arthur Berger, Henri Lubret, Tanguy Fenouil, Marion Schaefer, Clara Yzet, Thibault Degand, Thimothee Wallenhorst, Fabien Subtil, Arnaud Lemmers, Laura Gérard, João Santos‐Antunes, Lucas Barthet, Romain Gérard, Sohaib Ouazzani, Valérie Hervieu, Yann Le Baleur, Jérémie Jacques, Jean-Philippe Ratone, Vincent Lépilliez, Romain Legros, Mathieu Pioche, Sarah Leblanc, Stanislas Chaussade, Jérémie Albouys, Thomas Lambin, Philippe Leclercq, Jean-Baptiste Chevaux, Jérôme Rivory
article en

Abstract

Background Advances in colorectal cancer (CRC) screening and endoscopic techniques have led to increased detection of T1 CRC. Patient management relies on histopathological criteria predicting lymph node metastasis (LNM), including submucosal invasion depth (SID) >1000 µm. However, the independent prognostic value of isolated deep invasion remains unclear. Methods We performed a retrospective multicenter study of patients treated at 18 European centers between 2009 and 2022. Patients with T1 CRC endoscopically resected en bloc and with isolated SID >1000 µm (without other high-risk features) were included. Two groups were analyzed: patients who underwent additional surgery and those who were followed with surveillance. Rates of LNM (surgery group) and recurrence (local and distant; surveillance group) were assessed. Exploratory multivariable analyses were performed to evaluate clinicopathological factors associated with LNM. Results Among 179 included patients (124 surgery, 55 surveillance), LNM was found in 16/124 surgical specimens (12.9%; 95%CI 7.7-20.4) and recurrence occurred in 2/55 patients undergoing surveillance (3.6%; 95%CI 0.4-12.6). LNM occurred in 1/50 patients (2.0%) with SID <2000 µm and in 15/74 patients (20.3%) with SID ≥2000 µm. Multivariable analysis revealed SID ≥2000 µm (odds ratio [OR] 3.59; 95%CI 1.14-13.71) and colonic (vs. rectal) tumor location (OR 3.63; 95%CI 1.07-16.77) as factors associated with LNM. Conclusion Isolated deep submucosal invasion in T1 CRC was associated with a non-negligible rate of LNM in this real-world cohort. In exploratory analyses, SID ≥2000 µm was associated with LNM.

Endoscopy
University of Rome Tor Vergata (IT), Lyon College (US), Université de Lille (FR), London Clinic (GB), Erasmus Hospital (BE), Hospital de São João (PT), Centre Hospitalier Universitaire de Lille (FR), Hôpital Cochin (FR), Centre Hospitalier Universitaire Amiens-Picardie (FR), Centre Hospitalier Régional et Universitaire de Nancy (FR), Hôpital Européen Georges-Pompidou (FR), Bordeaux Population Health (FR), CIC Rennes (FR), Hôpital Edouard Herriot (FR), Hôpital Privé Jean Mermo (FR), Hospital Universitario de La Princesa (ES), Centre Hospitalier de Valence (FR), Hôpital Paris Saint-Joseph (FR), Maison des Sciences sociales et des Humanités de Dijon (FR), European Hospital (IT), Institut Paoli-Calmettes (FR), Université d'été de Boulogne-sur-Mer (FR), Centre Hospitalier Universitaire de Rennes (FR), Hôpital Dupuytren (FR)
Good health and well-being
Openalex Percentile: Top 13%
Colorectal Cancer Surgical Treatments
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