Background: The low positive predictive value for lymph node metastases (LNM) of common practice risk criteria (CPRC) in T1 colorectal carcinoma (CRC) leads to manyunnecessary additional surgeries following local resection. This study aimed to identify criteria that may improve on the CPRC. Methods: Logistic regression analysis was performed to determine the association of diverse variables with LNM or ‘poor outcome’ (LNM and/or distant metastases and/or recurrence) in a single center T1 CRC cohort. The diagnostic capacity of the set of variables obtained was compared with that of the CPRC. Results: The study comprised 161 cases. Poorly differentiated clusters (PDC) and tumor budding grade > 1 (TB > 1) were the only independent variables associated with LNM. The area under the curve (AUC) for these criteria was 0.808 (CI 95% 0.717–0.880) compared to 0.582 (CI 95% 0.479–0.680) for CPRC. TB > 1 and lymphovascular invasion (LVI) were independently associated with ‘poor outcome’, with an AUC of 0.801 (CI 95% 0.731–0.859), while the AUC for CPRC was 0.691 (CI 95% 0.603–0.752). TB > 1, combined either with PDC or LVI, would reduce false positives between 41.5% and 45% without significantly increasing false negatives. Conclusions: Indicating additional surgery in T1 CRC only when either TB > 1, PDC, or LVI are present could reduce unnecessary surgeries significantly.
背景：在T1期结直肠癌中，常规临床实践风险标准对淋巴结转移的阳性预测值较低，导致局部切除术后许多不必要的追加手术。本研究旨在探索能改进常规风险标准的评估指标。方法：对单中心T1期结直肠癌队列进行逻辑回归分析，评估多种变量与淋巴结转移或"不良预后"（淋巴结转移和/或远处转移和/或复发）的关联性。将所得变量组合的诊断效能与常规风险标准进行比较。结果：研究共纳入161例病例。低分化细胞簇和肿瘤出芽分级>1是与淋巴结转移唯一相关的独立变量。这些标准的曲线下面积为0.808（95%CI 0.717-0.880），而常规风险标准仅为0.582（95%CI 0.479-0.680）。肿瘤出芽分级>1和淋巴血管侵犯与"不良预后"独立相关，其曲线下面积为0.801（95%CI 0.731-0.859），而常规风险标准为0.691（95%CI 0.603-0.752）。肿瘤出芽分级>1分别与低分化细胞簇或淋巴血管侵犯组合时，可在不明显增加假阴性的情况下，将假阳性率降低41.5%至45%。结论：仅当存在肿瘤出芽分级>1、低分化细胞簇或淋巴血管侵犯时，才对T1期结直肠癌患者建议追加手术，可显著减少不必要的手术干预。
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