Novel predictors for lymph node metastasis in submucosal invasive colorectal carcinoma

AIM To evaluate a novel grading system to predict lymph node metastasis (LNM) in patients with submucosal invasive colorectal carcinoma (SICRC). METHODS We analyzed the associations between LNM and various clinicopathological features in 252 patients with SICRC who had undergone radical surgery at the Seoul Saint Mary's hospital between 2000 and 2015. RESULTS LNM was observed in 31 patients (12.3%). The depth and width of the submucosal invasion, lymphatic invasion, tumor budding, and the presence of poorly differentiated clusters (PDCs) were significantly associated with the incidence of LNM. Using multivariate analysis, the receiver operating characteristic curve was calculated and the area under curve (AUC) was used to compare the ability of the different parameters to identify the risk of LNM. The most powerful clinicopathological parameter for predicting LNM was lymphatic invasion (difference AUC = 0.204), followed by the presence or absence of tumor budding (difference AUC = 0.190), presence of PDCs (difference AUC = 0.172) and tumor budding graded by the Ueno method (difference AUC = 0.128). CONCLUSION Our results indicate that the tumor budding and the depth multiplied by the width measurements of submucosal invasion can provide important information for patients with SICRC.