Impact of revisions of the JSCCR guidelines on the treatment of T1 colorectal carcinomas in Japan

Abstract

Purpose: In 1977, the Japanese Society for Cancer of the Colon and Rectum (JSCCR) published the first edition of the general guidelines that described how to record clinical and histopathological findings of colorectal carcinomas (CRCs) and how to treat these cancers, and since then, the guidelines were revised several times. The aim of this study was to examine the impact of the revisions of the JSCCR guidelines on the treatment of submucosal CRCs (T1-CRCs) in Japanese clinical settings.

Methods: Questionnaires were sent to all 391 member institutions of the JSCCR. The questionnaires consisted of 2 parts: details of the institutions and treatment strategies for T1-CRCs.

Results: 73 (19 %) institutions responded to the survey. The number of treated T1-CRCs has increased year by year, and the rate of endoscopic resection for T1-CRCs has significantly increased with revisions of the guidelines (1417 [47 %] of 2985 T1-CRCs in 2003 – 2005, 2110 [50 %] of 4212 in 2006 – 2008, and 2546 [54 %] of 4686 in 2009 – 2011, P<.05).

Conclusion: The revisions of the JSCCR guidelines have influenced the treatment of T1-CRCs in Japanese clinical settings. There is room to revise the criteria for curative endoscopic resection to avoid unnecessary surgeries.

Zusammenfassung

Ziel: Im Jahr 1977 veröffentlichte die Japanese Society for Cancer of the Colon and Rectum (JSCCR) die erste Ausgabe der allgemeinen Leitlinien über die Dokumentation von histopathologischen Befunden und die Behandlung kolorektaler Karzinome (KRK). Seitdem wurden die Leitlininen mehrfach überarbeitet. Ziel dieser Studie war es, den Einfluss der Revisionen der JSCCR-Leitlinien auf die Behandlung von KRKs der Submukosa (T1-Karzinome) im klinischen Umfeld in Japan zu untersuchen.

Methoden: An alle 391 Mitgliedseinrichtungen der JSCCR wurden Fragebögen versandt. Diese bestanden aus zwei Teilen: genaue Angaben zur Einrichtung und Behandlungsstrategien für T1-Karzinome.

Ergebnisse: 73 Institutionen (19 %) beantworteten die Umfrage. Die Anzahl der behandelten T1-Karzinome hat jedes Jahr zugenommen und der Anteil der endoskopischen Resektionen von T1-Karzinomen ist mit den Revisionen der Leitlinien signifikant gestiegen (1417 [47 %] von 2985 T1-Karzinomen in den Jahren 2003 – 2005, 2110 [50 %] von 4212 in den Jahren 2006 – 2008, und 2546 [54 %] von 4686 in den Jahren 2009 – 2011, P<.05).

Schlussfolgerung: Die Revisionen der JSCCR-Leitlinien haben die Behandlung von kolorektalen T1-Karzinomen im klinischen Umfeld in Japan beeinflusst. Die Überprüfung der Kriterien für kurative endoskopische Resektionen wäre wünschenswert, um überflüssige Eingriffe zu vermeiden.

Schlüsselwörter

kolorektale T1-Karzinome - Fragebogen - endoskopische Resektion - zusätzliche chirurgische Resektion - JSCCR-Richtlinien 2005 - JSCCR-Richtlinien 2009/10

Key words

T1 colorectal carcinoma - questionnaires - endoscopic resection - additional surgical resection - JSCCR guideline 2005 - JSCCR guideline 2009/10

• References

• 1 Matsuda T, Marugame T, Kamo K et al. Cancer incidence and incidence rates in Japan in 2006: based on data from 15 population-based cancer registries in the monitoring of cancer incidence in Japan (MCIJ) project. Jpn J Clin Oncol 2012; 42: 139-147
• 2 Macafee DA, Waller M, Whynes DK et al. Population screening for colorectal cancer: the implications of an ageing population. Br J Cancer 2008; 99: 1991-2000
• 3 Stock C, Pulte D, Haug U et al. Subsite-specific colorectal cancer risk in the colorectal endoscopy era. Gastrointest Endosc 2012; 75: 621-630
• 4 Kudo S, Hirota S, Nakajima T et al. Colorectal tumours and pit pattern. J Clin Pathol 1994; 47: 880-885
• 5 Kanao H, Tanaka S, Oka S et al. Narrow-band imaging magnification predicts the histology and invasion depth of colorectal tumors. Gastrointest Endosc 2009; 69: 631-636
• 6 Tanaka S, Oka S, Kaneko I et al. Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc 2007; 66: 100-107
• 7 Terasaki M, Tanaka S, Oka S et al. Clinical outcomes of endoscopic submucosal dissection and endoscopic mucosal resection for laterally spreading tumors larger than 20 mm. J Gastroenterol Hepatol 2012; 27: 734-740
• 8 Nakadoi K, Tanaka S, Kanao H et al. Management of T1 colorectal carcinoma with special reference to criteria for curative endoscopic resection. J Gastroenterol Hepatol 2012; 27: 1057-1062
• 9 Japanese Society for Cancer of the Colon and Rectum. JSCCR guidelines 2005 for the treatment of colorectal cancer. Kanehara & Co., Ltd., Tokyo: 2005
• 10 Japanese Society for Cancer of the Colon and Rectum. JSCCR guidelines 2009 for the treatment of colorectal cancer. Tokyo: Kanehara & Co., Ltd.; 2009
• 11 Watanabe T, Itabashi M, Shimada Y et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol 2012; 17: 1-29
• 12 Nakajima T, Saito Y, Tanaka S et al. Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan. Surg Endosc 27: 3262-3270
• 13 Tanaka S, Haruma K, Teixeira CR et al. Endoscopic treatment of submucosal invasive colorectal carcinoma with special reference to risk factors for lymph node metastasis. J Gastroenterol 1995; 30: 710-717
• 14 Wilcox GM, Anderson PB, Colacchio TA. Early invasive carcinoma in colonic polyps. A review of the literature with emphasis on the assessment of the risk of metastasis. Cancer 1986; 57: 160-171
• 15 Cooper HS. Surgical pathology of endoscopically removed malignant polyps of the colon and rectum. Am J Surg Pathol 1983; 7: 613-623
• 16 Japanese Society for Cancer of the Colon and Rectum. General rules for clinical and pathological studies on cancer of the colon, rectum and anus. Tokyo: Kanehara & Co., Ltd; 1980 2nd edn.
• 17 Kudo S. Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy 1993; 25: 455-461
• 18 Kikuchi R, Takano M, Takagi K et al. Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. Dis Colon Rectum 1995; 38: 1286-1295
• 19 Kitajima K, Fujimori T, Fujii S et al. Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study. J Gastroenterol 2004; 39: 534-543
• 20 Ueno H, Mochizuki H, Hashiguchi Y et al. Risk factors for an adverse outcome in early invasive colorectal carcinoma. Gastroenterology 2004; 127: 385-394
• 21 Oka S, Tanaka S, Kanao H et al. Mid-term prognosis after endoscopic resection for submucosal colorectal carcinoma: summary of a multicenter questionnaire survey conducted by the colorectal endoscopic resection standardization implementation working group in Japanese Society for Cancer of the Colon and Rectum. Dig Endosc 2011; 23: 190-194
• 22 Ikematsu H, Yoda Y, Matsuda T et al. Long-term outcomes after resection for submucosal invasive colorectal cancers. Gastroenterology 2013; 144: 551-559
• 23 Tanaka S, Haruma K, Hiraga Y et al. Curative indications for endoscopic mucosal resection of early colorectal carcinoma, with special reference to lymph node metastasis [in Japanese with English abstract]. Early Colorectal Cancer (Tokyo) 1998; 2: 655-662
• 24 Tanaka S, Haruma K, Oh-E H et al. Possibility of broadening of the indication for endoscopic treatment for submucosally invasive colorectal carcinoma and the risks involved: analysis of cases with submucosally invasive carcinoma treated endoscopically [in Japanese with English abstract]. Stomach Intestine (Tokyo) 1999; 34: 757-764
• 25 Tanaka S, Haruma K, Oh-E H et al. Conditions of curability after endoscopic resection for colorectal carcinoma with submucosally massive invasion. Oncol Rep 2000; 7: 783-788
• 26 Oka S, Tanaka S, Nakadoi K et al. Risk analysis of submucosal invasive rectal carcinomas for lymph node metastasis to expand indication criteria for endoscopic resection. Dig Endosc 2013; 25 (Suppl. 02) 21-25
• 27 Ueno H, Hase K, Hashiguchi Y et al. Novel risk factors for lymph node metastasis in early invasive colorectal cancer: a multi-institution pathology review. J Gastroenterol 2013 [Epub ahead of print]
• 28 Ogawa T, Yoshida T, Tsuruta T et al. Tumor budding is predictive of lymphatic involvement and lymph node metastases in submucosal invasive colorectal adenocarcinomas and in non-polypoid compared with polypoid growths. Scand J Gastroenterol 2009; 44: 605-614
• 29 Yasuda K, Inomata M, Shiromizu A et al. Risk factors for occult lymph node metastasis of colorectal cancer invading the submucosa and indications for endoscopic mucosal resection. Dis Colon Rectum 2007; 50: 1370-1376
• 30 Qi G, Tuncel H, Aoki E et al. Intracellular localization of survivin determines biological behavior in colorectal cancer. Oncol Rep 2009; 22: 557-562
• 31 Berg M, Guriby M, Nordgård O et al. Influence of microsatellite instability, KRAS and BRAF mutations on lymph node harvest in stage I-III colon cancers. Mol Med 2013; [Epub ahead of print]
• 32 Li D, Wei P, Peng Z et al. The critical role of dysregulated FOXM1-PLAUR signaling in human colon cancer progression and metastasis. Clin Cancer Res 2013; 19: 62-72
• 33 Watanabe T, Kobunai T, Tanaka T et al. Gene expression signature and the prediction of lymph node metastasis in colorectal cancer by DNA microarray. Dis Colon Rectum 2009; 52: 1941-1948
• 34 Boland CR, Thibodeau SN, Hamilton SR et al. A National Cancer Institute Workshop on Microsatellite Instability for cancer detection and familial predisposition: development of international criteria for the determination of microsatellite instability in colorectal cancer. Cancer Res 1998; 58: 5248-5257
• 35 Zhou XP, Hoang JM, Li YJ et al. Determination of the replication error phenotype in human tumors without the requirement for matching normal DNA by analysis of mononucleotide repeat microsatellites. Genes Chromosomes Cancer 1998; 21: 101-107
• 36 Yoshii S, Nojima M, Nosho K et al. Factors associated with risk for colorectal cancer resurrence after endoscopic resection of t1 tumors. Clin Gastroenterol Hepatol 12: 292-302
• 37 Higuchi T, Enomoto M, Sugihara K. Optimal follow-up of stage I colorectal cancer patients. J Ipn Soc Coloproctol 59: 857-862 (in Japanese with English abstract)