Predictors of lymph node metastases in patients with malignant adenomatous polyps of the colon.

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.