American journal of surgery · 2021
Predictors of lymph node metastases in patients with malignant adenomatous polyps of the colon.
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Artinyan Avo, Wai Christina, Zhu Ruoyan, Sutanto Christine, Sargsyan Roman, Kasheri Eli, Oka Kimberly, Cohen Jason, Nasseri Yosef
Аннотация
BACKGROUND: We sought to describe predictors of lymph node positivity in patients with malignant colon polyps to identify low risk patients who may potentially avoid radical surgery.
DESIGN: The National Cancer Database (2010-2015) was queried for all patients with malignant colonic polyps who underwent formal colonic resection. Univariate and multivariate methods were used to determine independent predictors of lymph node metastasis.
RESULTS: 14,663 patients were identified. Lymph node disease was present in 9% of patients. High-grade disease, LVI, PNI, younger age, and left sided location were univariate predictors of lymph node disease. High-grade disease (OR 1.84), left sided location (OR 1.31), LVI (OR 5.79), and PNI (OR 1.70) were independent predictors, while elderly age (OR 0.64) was protective (all p-values <0.001). Elderly patients with low grade disease of the right/transverse colon without LVI/PNI had a 4.4% risk of lymph node disease. High grade, left-sided tumors with LVI, non-elderly age, had a 30% risk.
CONCLUSION: Non-elderly age, left-sided location, LVI, PNI and high-grade histology are independent predictors of lymph node metastasis in malignant colonic polyps.
DESIGN: The National Cancer Database (2010-2015) was queried for all patients with malignant colonic polyps who underwent formal colonic resection. Univariate and multivariate methods were used to determine independent predictors of lymph node metastasis.
RESULTS: 14,663 patients were identified. Lymph node disease was present in 9% of patients. High-grade disease, LVI, PNI, younger age, and left sided location were univariate predictors of lymph node disease. High-grade disease (OR 1.84), left sided location (OR 1.31), LVI (OR 5.79), and PNI (OR 1.70) were independent predictors, while elderly age (OR 0.64) was protective (all p-values <0.001). Elderly patients with low grade disease of the right/transverse colon without LVI/PNI had a 4.4% risk of lymph node disease. High grade, left-sided tumors with LVI, non-elderly age, had a 30% risk.
CONCLUSION: Non-elderly age, left-sided location, LVI, PNI and high-grade histology are independent predictors of lymph node metastasis in malignant colonic polyps.