Oncologic outcomes of screen-detected and non-screen-detected T1 colorectal cancers

Abstract

Background The incidence of T1 colorectal cancer (CRC) has increased with the implementation of CRC screening programs. It is unknown whether the outcomes and risk models for T1 CRC based on non-screen-detected patients can be extrapolated to screen-detected T1 CRC. This study aimed to compare the stage distribution and oncologic outcomes of T1 CRC patients within and outside the screening program.

Methods Data from T1 CRC patients diagnosed between 2014 and 2017 were collected from 12 hospitals in the Netherlands. The presence of lymph node metastasis (LNM) at diagnosis was compared between screen-detected and non-screen-detected patients using multivariable logistic regression. Cox proportional hazard regression was used to analyze differences in the time to recurrence (TTR), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival. Additionally, the performance of conventional risk factors for LNM was evaluated across the groups.

Results 1803 patients were included (1114 [62%] screen-detected), with median follow-up of 51 months (interquartile range 30). The proportion of LNM did not significantly differ between screen- and non-screen-detected patients (12.6% vs. 8.9%; odds ratio 1.41; 95%CI 0.89–2.23); a prediction model for LNM performed equally in both groups. The 3- and 5-year TTR, MFS, and CSS were similar for patients within and outside the screening program. However, overall survival was significantly longer in screen-detected T1 CRC patients (adjusted hazard ratio 0.51; 95%CI 0.38–0.68).

Conclusions Screen-detected and non-screen-detected T1 CRCs have similar stage distributions and oncologic outcomes and can therefore be treated equally. However, screen-detected T1 CRC patients exhibit a lower rate of non-CRC-related mortality, resulting in longer overall survival.

Publikationsverlauf

Eingereicht: 09. August 2023

Angenommen nach Revision: 05. Februar 2024

Accepted Manuscript online:
07. Februar 2024

Artikel online veröffentlicht:
13. März 2024

• References

• 1 Breekveldt ECH, Lansdorp-Vogelaar I, Toes-Zoutendijk E. et al. Colorectal cancer incidence, mortality, tumour characteristics, and treatment before and after introduction of the faecal immunochemical testing-based screening programme in the Netherlands: a population-based study. Lancet Gastroenterol Hepatol 2022; 7: 60-68
• 2 Hu Z, Ding J, Ma Z. et al. Quantitative evidence for early metastatic seeding in colorectal cancer. Nat Genet 2019; 51: 1113-1122
• 3 Senore C, Giovo I, Ribaldone DG. et al. Management of Pt1 tumours removed by endoscopy during colorectal cancer screening: Outcome and treatment quality indicators. Eur J Surg Oncol 2018; 44: 1873-1879
• 4 Richards CH, Ventham NT, Mansouri D. et al. An evidence-based treatment algorithm for colorectal polyp cancers: results from the Scottish Screen-detected Polyp Cancer Study (SSPoCS). Gut 2018; 67: 299-306
• 5 Grainville T, Bretagne J-F, Piette C. et al. Management of T1 colorectal cancers detected at screening colonoscopy: A study from the French national screening programme. Dig Liver Dis 2020; 52: 909-917
• 6 Fasoli R, Nienstedt R, de Carli N. et al. The management of malignant polyps in colorectal cancer screening programmes: A retrospective Italian multi-centre study. Dig Liver Dis 2015; 47: 715-719
• 7 Kudo S, Ichimasa K, Villard B. et al. Artificial intelligence system to determine risk of T1 colorectal cancer metastasis to lymph node. Gastroenterology 2021; 160: 1075-1084.e2
• 8 Rönnow C-F, Arthursson V, Toth E. et al. Lymphovascular infiltration, not depth of invasion, is the critical risk factor of metastases in early colorectal cancer: retrospective population-based cohort study on prospectively collected data, including validation. Ann Surg 2022; 275: e148-e154
• 9 Backes Y, Elias SG, Groen JN. et al. Histologic factors associated with need for surgery in patients with pedunculated T1 colorectal carcinomas. Gastroenterology 2018; 154: 1647-1659
• 10 Kessels K, Backes Y, Elias SG. et al. Pedunculated morphology of T1 colorectal tumors associates with reduced risk of adverse outcome. Clin Gastroenterol Hepatol 2019; 17: 1112-1120.e1
• 11 Suh JH, Han KS, Kim BC. et al. Predictors for lymph node metastasis in T1 colorectal cancer. Endoscopy 2012; 44: 590-595
• 12 Bosch S, Teerenstra S, de Wilt JW. et al. Predicting lymph node metastasis in pT1 colorectal cancer: A systematic review of risk factors providing rationale for therapy decisions. Endoscopy 2013; 45: 827-834
• 13 Takamaru H, Saito Y, Sekiguchi M. et al. Endoscopic resection before surgery does not affect the recurrence rate in patients with high-risk T1 colorectal cancer. Clin Transl Gastroenterol 2021; 12: e00336
• 14 Levic K, Bulut O, Hansen TP. et al. Malignant colorectal polyps: endoscopic polypectomy and watchful waiting is not inferior to subsequent bowel resection. A nationwide propensity score-based analysis. Langenbecks Arch Surg 2019; 404: 231-242
• 15 Chang L-C, Shun C-T, Lin B-R. et al. Recurrence outcomes less favorable in T1 rectal cancer than in T1 colon cancer. Oncologist 2021; 26: e1548-e1554
• 16 de Neree tot Babberich MPM, Vermeer NCA, Wouters MWJM. et al. Postoperative outcomes of screen-detected vs non–screen-detected colorectal cancer in the Netherlands. JAMA Surg 2018; 153: e183567
• 17 Weiss NS, Rossing MA. Healthy screenee bias in epidemiologic studies of cancer incidence. Epidemiology 1999; 7: 319-322
• 18 von Wagner C, Good A, Wright D. et al. Inequalities in colorectal cancer screening participation in the first round of the national screening programme in England. Br J Cancer 2009; 101: S60-S63
• 19 de Klerk CM, Gupta S, Dekker E. et al. Socioeconomic and ethnic inequities within organised colorectal cancer screening programmes worldwide. Gut 2018; 67: 679-687
• 20 van der Meulen MP, Toes-Zoutendijk E, Spaander MCW. et al. Socioeconomic differences in participation and diagnostic yield within the Dutch national colorectal cancer screening programme with faecal immunochemical testing. PLoS One 2022; 17: e0264067
• 21 Kooyker AI, de Jonge L, Toes-Zoutendijk E. Colorectal cancer stage-distribution at first and repeat fecal immunohistochemical test screening. Clin Gastroenterol Hepatol 2023; 21: 3424-3432.e2