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Multicenter Study
. 2024 Jul;56(7):484-493.
doi: 10.1055/a-2263-2841. Epub 2024 Feb 7.

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

Lisa van der Schee  1   2 , Krijn J C Haasnoot  1 , Sjoerd G Elias  3 , Kim M Gijsbers  1   4 , Yasser A Alderlieste  5 , Yara Backes  1 , Anne-Marie van Berkel  6 , Femke Boersma  7 , Frank Ter Borg  4 , Emilie C H Breekveldt  8   9 , Koen Kessels  10 , Miriam Koopman  11 , Iris Lansdorp-Vogelaar  8 , Monique E van Leerdam  9   12 , Gertjan Rasschaert  13 , Ramon-Michel Schreuder  14 , Ruud W M Schrauwen  15 , Tom C J Seerden  13 , Marcel B W Spanier  16 , Jochim S Terhaar Sive Droste  17 , Esther Toes-Zoutendijk  8 , Jurriaan B Tuynman  18 , Geraldine R Vink  11   19 , Wouter H de Vos Tot Nederveen Cappel  20 , Frank P Vleggaar  1 , Miangela M Laclé #  2 , Leon M G Moons #  1
Affiliations
Multicenter Study

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

Lisa van der Schee et al. Endoscopy. 2024 Jul.

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.

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Conflict of interest statement

M. Koopman has an advisory role for Eisai, Nordic Farma, Merck-Serono, Pierre Fabre, and Servier and has received institutional grants from Bayer, Bristol Myers Squibb, Merck, Personal Genome Diagnostics (PGDx), Pierre Fabre, Roche, Sirtex, and Servier. G.R. Vink has received institutional grants from BMS, Merck, Servier, Personal Genome, Diagnostics, Bayer, Sirtex, Pierre Fabre, Lilly, and Delfi Diagnostics. F.P. Vleggaar is a consultant for Boston Scientific. L.M.G. Moons is a consultant for Boston Scientific. L. van der Schee, K.J.C. Haasnoot, S.G. Elias, K.M. Gijsbers, Y.A. Alderlieste, Y. Backes, A.-M. van Berkel, F. Boersma, F. ter Borg, E.C.H. Breekveldt, K. Kessels, I. Lansdorp-Vogelaar, M.E. van Leerdam, G. Rasschaert, R.-M. Schreuder, R.W.M. Schrauwen, T.C.J. Seerden, M.B.W.M. Spanier, J.S. Terhaar Sive Droste, E. Toes-Zoutendijk, J.B. Tuynman, W.H. de Vos tot Nederveen Cappel, and M.M. Laclé declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart of included T1 colorectal cancer (CRC) patients.
Fig. 2
Fig. 2
Treatment strategies and oncologic outcomes within the subgroup of 1268 endoscopically resected screen-detected and non-screen-detected T1 colorectal cancers (CRCs), subdivided according to histopathologic risk group. * High risk was defined as having one or more of the following histopathologic risk factors: lymphovascular invasion, poor differentiation, positive resection margin (R1) or non-assessable resection margin (Rx). In the absence of all of these risk factors, a T1 CRC was classified as low risk. When all known risk factors were absent, but one or more risk factors were missing, a T1 CRC was classified as being of undetermined risk.
Fig. 3
Fig. 3
Outcomes of screen-detected and non-screen-detected T1 colorectal cancer (CRC) patients in terms of: a time to recurrence; b metastasis-free survival; c cancer-specific survival; d overall survival.
See this image and copyright information in PMC

References

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