{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:55:55Z","timestamp":1760061355304,"version":"build-2065373602"},"reference-count":31,"publisher":"Georg Thieme Verlag KG","issue":"CP","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Yang Ming Chiao Tung University Hospital, Yilan","award":["RD2023-001"],"award-info":[{"award-number":["RD2023-001"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endosc Int Open"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The aim of this study was to validation the accuracy of major guidelines and their adopted unfavorable histologic factors for lymph node metastasis (LNM) in pT1 colorectal cancer (CRC). National Comprehensive Cancer Network (NCCN), Japanese Society for Cancer of the Colon and Rectum (JSCCR), European Society for Medical Oncology (ESMO), and French Intergroup Clinical Practice Guidelines (FICPG) were included.<\/jats:p><jats:p>Retrospectively, 519 cases receiving oncological resection with lymphadenectomy were included. Factors and four pathological parameters--histological differentiation grades (HDG), lymphovascular invasion (LVI), depth of submucosal invasion (DSI)(&gt;1000\u03bcm), and tumor budding (TB)--were analyzed for their impact on LNM incidence individually and in combination as defined by the guidelines.<\/jats:p><jats:p>HDG, LVI, TB, and gender (female) are risk factors for LNM in multivariate analysis. All guidelines have significant ability to predict LNM (P&lt;0.001). NCCN and ESMO have similar performance, in terms of sensitivity (63.8%\/68.1%) and specificity (62.7%\/69.5%). JSCCR and FICPG had similar performance in terms of good sensitivity (100%\/100%) and low specificity (25.6%\/25.2%). The JSCCR\/FICPG group had higher sensitivity and lower specificity and accuracy than the NCCN\/ESMO group.<\/jats:p><jats:p>HDG, LVI, TB, and gender (female) are independent risk factors for LNM of T1 CRC. DSI is an excellent negative predictor, although not an independent risk factor. The NCCN\/ESMO guideline has medium sensitivity and requires improvement. The JSCCR\/FICPG guideline has perfect sensitivity but low specificity, thus exposing patients to many unnecessary surgeries. There is revision potential for current guideline factors, including those beyond current pathological ones, to improve LNM prediction accuracy.<\/jats:p>","DOI":"10.1055\/a-2697-7786","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T23:01:20Z","timestamp":1757372480000},"source":"Crossref","is-referenced-by-count":0,"special_numbering":"S","title":["Retrospective accuracy analysis of major guidelines and factors for lymph node metastasis of pT1 colorectal cancer"],"prefix":"10.1055","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7262-4101","authenticated-orcid":false,"given":"ChunChi","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei City, Taiwan"},{"name":"Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen-Yih","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan"},{"name":"Department of Pathology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jui-Shen","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei City, Taiwan"},{"name":"Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shih-Ching","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei City, Taiwan"},{"name":"Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shung-Haur","family":"Yang","sequence":"additional","affiliation":[{"name":"Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei City, Taiwan"},{"name":"Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan"},{"name":"Department of Surgery, En Chu Kong Hospital of the Hsing Tian Kong Foundation Medical Mission, New Taipei City, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"e1548","DOI":"10.1002\/onco.13815","article-title":"Recurrence outcomes less favorable in T1 rectal cancer than in t1 colon cancer","volume":"26","author":"LC Chang","year":"2021","journal-title":"Oncologist"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1055\/s-0033-1344238","article-title":"Predicting lymph node metastasis in pT1 colorectal cancer: a systematic review of risk factors providing rationale for therapy decisions","volume":"45","author":"SL Bosch","year":"2013","journal-title":"Endoscopy"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1007\/s10350-004-6147-7","article-title":"Risk of lymph node metastasis in T1 carcinoma of the colon and rectum","volume":"45","author":"R Nascimbeni","year":"2002","journal-title":"Dis Colon Rectum"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10147-019-01485-z","article-title":"Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer","volume":"25","author":"Y Hashiguchi","year":"2020","journal-title":"Int J Clin Oncol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1291","DOI":"10.1016\/j.annonc.2020.06.022","article-title":"Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"31","author":"G Argil\u00e9s","year":"2020","journal-title":"Ann Oncol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1016\/j.dld.2024.01.208","article-title":"Non-metastatic colon cancer: French Intergroup Clinical Practice Guidelines for diagnosis, treatments, and follow-up (TNCD, SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, SFP, AFEF, and SFR)","volume":"56","author":"T Lecomte","year":"2024","journal-title":"Dig Liver Dis"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1299","DOI":"10.1038\/modpathol.2017.46","article-title":"Recommendations for reporting tumor budding in colorectal cancer based on the International Tumor Budding Consensus Conference (ITBCC) 2016","volume":"30","author":"A Lugli","year":"2017","journal-title":"Modern Path"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1016\/0016-5085(85)90333-6","article-title":"Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy","volume":"89","author":"RC Haggitt","year":"1985","journal-title":"Gastroenterology"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1007\/978\/-3-319-40618-3","volume-title":"AJCC Cancer Staging Manual 8 Edition","author":"B Mahul","year":"2017","edition":"8th ed."},{"key":"ref13","volume-title":"Colorectal adenocarcinoma. WHO Classification of Tumors: Digestive System Tumours","author":"ID Nagtegal","year":"2019","edition":"5th ed"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"794","DOI":"10.1007\/BF02562132","article-title":"The clinical significance of vascular invasion in colorectal cancer","volume":"32","author":"B Minsky","year":"1989","journal-title":"Dis Colon Rectum"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1007\/s00535-004-1339-4","article-title":"Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study","volume":"39","author":"K Kitajima","year":"2004","journal-title":"J Gastroenterol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1053\/j.gastro.2022.04.010","article-title":"Deep submucosal invasion is not an independent risk factor for lymph node metastasis in T1 colorectal cancer: a meta-analysis","volume":"163","author":"LW Zwager","year":"2022","journal-title":"Gastroenterol"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"1647","DOI":"10.1053\/j.gastro.2018.01.023","article-title":"Histologic factors associated with need for surgery in patients with pedunculated T1 colorectal carcinomas","volume":"154","author":"Y Backes","year":"2018","journal-title":"Gastroenter"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1002\/1097-0142(19890201)63:3<539::aid-cncr2820630323>3.0.co;2-s","article-title":"An index for estimating the probability of lymph node metastasis in rectal cancers. Lymph node metastasis and the histopathology of actively invasive regions of cancer","volume":"63","author":"T Morodomi","year":"1989","journal-title":"Cancer"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1053\/j.gastro.2004.04.022","article-title":"Risk factors for an adverse outcome in early invasive colorectal carcinoma","volume":"127","author":"H Ueno","year":"2004","journal-title":"Gastroenterol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1016\/j.humpath.2015.08.007","article-title":"Tumor budding in colorectal cancer--ready for diagnostic practice?","volume":"47","author":"VH Koelzer","year":"2016","journal-title":"Hum Pathol"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"534","DOI":"10.5858\/arpa.2021-0598-OA","article-title":"interobserver variability in assessment of depth of submucosal invasion for colonic endoscopic resections among subspecialized gastrointestinal pathologists","volume":"147","author":"DM Karamchandani","year":"2022","journal-title":"Arch Pathol Lab Med"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1055\/s-0043-122385","article-title":"Artificial intelligence may help in predicting the need for additional surgery after endoscopic resection of T1 colorectal cancer","volume":"50","author":"K Ichimasa","year":"2018","journal-title":"Endoscopy"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2023.1229998","article-title":"An artificial intelligence prediction model outperforms conventional guidelines in predicting lymph node metastasis of T1 colorectal cancer","volume":"13","author":"ZH Piao","year":"2023","journal-title":"Frontiers Oncol"},{"key":"ref25","doi-asserted-by":"crossref","DOI":"10.3389\/fonc.2024.1475270","article-title":"Comparative prediction of lymph node metastasis in pT1 colorectal cancer among Western and Japanese guidelines","volume":"14","author":"F Tanino","year":"2024","journal-title":"Frontiers Oncol"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1337576","article-title":"Commentary: An artificial intelligence prediction model outperforms conventional guidelines in predicting lymph node metastasis of T1 colorectal cancer","volume":"14","author":"K Ichimasa","year":"2024","journal-title":"Frontiers Oncol"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1002\/ueg2.12521","article-title":"Lymph node metastases and recurrence in pT1 colorectal cancer: Prediction with the International Budding Consortium Score\u2014A retrospective, multi-centric study","volume":"12","author":"H Dawson","year":"2024","journal-title":"United Europ Gastroenterol J"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1097\/SLA.0000000000005684","article-title":"Prognostic factors for lymph node metastases in pT1 colorectal cancer differ according to tumor morphology: A nationwide cohort study","volume":"277","author":"AL Ebbeh\u00f8j","year":"2023","journal-title":"Ann Surg"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1007\/s00535-010-0341-2","article-title":"Characteristics of recurrence after curative resection for T1 colorectal cancer: Japanese multicenter study","volume":"46","author":"H Kobayashi","year":"2011","journal-title":"J Gastroenterol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1055\/s-0033-1344234","article-title":"A large-scale multicenter study of long-term outcomes after endoscopic resection for submucosal invasive colorectal cancer","volume":"45","author":"Y Yoda","year":"2013","journal-title":"Endoscopy"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.cgh.2016.08.041","article-title":"Long-term recurrence-free survival after standard endoscopic resection versus surgical resection of submucosal invasive colorectal cancer: A population-based study","volume":"15","author":"TD Belderbos","year":"2017","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"2862","DOI":"10.1007\/s00464-020-07722-1","article-title":"The effect of non-curative endoscopic resection on cT1N0M0 colorectal carcinoma patients who underwent additional surgery","volume":"35","author":"Y Liu","year":"2021","journal-title":"Surg Endosc"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1016\/j.gie.2022.07.016","article-title":"Subpopulation analysis of survival in high-risk T1 colorectal cancer: surgery versus endoscopic resection only","volume":"96","author":"RK Ha","year":"2022","journal-title":"Gastrointest Endosc"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"2418","DOI":"10.14309\/ajg.0000000000002879","article-title":"Long-term outcomes of additional surgery after endoscopic resection versus primary surgery for T1 colorectal cancer","volume":"119","author":"Y Tamaru","year":"2024","journal-title":"Am J Gastroenterol"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1093\/bjsopen\/zrae053","article-title":"Risk of recurrence in high-risk T1 colon cancer following endoscopic and surgical resection: registry-based cohort study","volume":"8","author":"E Nilsson","year":"2024","journal-title":"BJS Open"}],"container-title":["Endoscopy International Open"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2697-7786.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T22:53:05Z","timestamp":1760050385000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2697-7786"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,8]]},"references-count":31,"journal-issue":{"issue":"CP","published-online":{"date-parts":[[2025,1,7]]},"published-print":{"date-parts":[[2025]]}},"alternative-id":["a26977786"],"URL":"https:\/\/doi.org\/10.1055\/a-2697-7786","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2364-3722","2196-9736"],"issn-type":[{"type":"print","value":"2364-3722"},{"type":"electronic","value":"2196-9736"}],"subject":[],"published-other":{"date-parts":[[2025,9,8]]},"published":{"date-parts":[[2025,9,8]]}}}