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Reappraisal of the characteristics, management, and prognosis of intramucosal colorectal cancers and their comparison with T1 carcinomas.
Gastrointest Endosc. 2020 Jun 23 [Online ahead of print]GE

Abstract

BACKGROUND AND AIMS

The recent description of 'invasive' forms of intramucosal carcinomas (IMCs) has rekindled interest in studying the characteristics, management and prognosis of IMCs and comparing them to T1 colorectal cancers (CRCs).

METHODS

This population-based study included 282 cases of IMC and 207 cases of T1 CRC diagnosed by colonoscopy after a positive fecal blood test through a screening program.

RESULTS

IMC presented mainly in the form of pedunculated polyps (68.4%) located in the distal colon (69.9%) with a size ≥20 mm (60.6%). IMCs were endoscopically resected in 227 (80.5%) patients and surgically resected in 55 (19.5%) patients. Surgical patients had more right-sided, more sessile, and larger lesions. There was no sign of lymphovascular invasion. Compared with T1 CRC, IMC demonstrated lower rates of sessile polyps (31.6% vs 49.8%, p<0.0001), primary and ultimate surgical treatment (19.5% vs 39.1% and 19.9% vs 78.7%, p<0.0001, respectively), lymph node metastasis in surgical patients (0% vs 9.5%, p=0.041), cancer recurrence and cancer-related mortality (0% vs 5.6% and 0% vs 2.5%, respectively), and bleeding after endoscopic resection (1.8% vs 8.7%, p=0.001). By multivariate analysis of the pooled cohort (IMC + T1 CRC, n=489), the factors significantly associated with first line surgery were shown to be polyp characteristics and the gastroenterologist having performed the colonoscopy.

CONCLUSIONS

IMCs account for a quarter of all screen-detected CRC. They have an excellent prognosis regardless of whether endoscopic or surgical treatment is performed. IMCs differ significantly from T1 carcinomas in terms of management and prognosis.

Authors+Show Affiliations

Department of Gastroenterology, University Hospital, 35033 Rennes, France.Rennes 1 University, 35000 Rennes, France. Electronic address: jf.bretagne@gmail.com.ADECI 35 (Association pour le Dépistage des Cancers en Ille-et-Vilaine), 35040 Rennes, France.Department of Biostatistics, University Hospital, 35033 Rennes, France.Department of Gastroenterology, University Hospital, 35033 Rennes, France.ADECI 35 (Association pour le Dépistage des Cancers en Ille-et-Vilaine), 35040 Rennes, France.Department of Gastroenterology, University Hospital, 35033 Rennes, France; Rennes 1 University, 35000 Rennes, France; ADECI 35 (Association pour le Dépistage des Cancers en Ille-et-Vilaine), 35040 Rennes, France; COSS (Chemistry Oncogenesis Stress Signaling), UMR_S 1242, Rennes, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32590054

Citation

Bordet, Martin, et al. "Reappraisal of the Characteristics, Management, and Prognosis of Intramucosal Colorectal Cancers and Their Comparison With T1 Carcinomas." Gastrointestinal Endoscopy, 2020.
Bordet M, Bretagne JF, Piette C, et al. Reappraisal of the characteristics, management, and prognosis of intramucosal colorectal cancers and their comparison with T1 carcinomas. Gastrointest Endosc. 2020.
Bordet, M., Bretagne, J. F., Piette, C., Rousseau, C., Grainville, T., Cosson, M., & Lièvre, A. (2020). Reappraisal of the characteristics, management, and prognosis of intramucosal colorectal cancers and their comparison with T1 carcinomas. Gastrointestinal Endoscopy. https://doi.org/10.1016/j.gie.2020.06.052
Bordet M, et al. Reappraisal of the Characteristics, Management, and Prognosis of Intramucosal Colorectal Cancers and Their Comparison With T1 Carcinomas. Gastrointest Endosc. 2020 Jun 23; PubMed PMID: 32590054.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reappraisal of the characteristics, management, and prognosis of intramucosal colorectal cancers and their comparison with T1 carcinomas. AU - Bordet,Martin, AU - Bretagne,Jean-François, AU - Piette,Christine, AU - Rousseau,Chloé, AU - Grainville,Thomas, AU - Cosson,Mathilde, AU - Lièvre,Astrid, Y1 - 2020/06/23/ PY - 2020/03/20/received PY - 2020/06/10/accepted PY - 2020/6/27/entrez PY - 2020/6/27/pubmed PY - 2020/6/27/medline KW - T1 colorectal cancer KW - colorectal cancer KW - colorectal cancer prognosis KW - colorectal cancer screening KW - endoscopic therapy KW - intramucosal cancer KW - surgical treatment JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. N2 - BACKGROUND AND AIMS: The recent description of 'invasive' forms of intramucosal carcinomas (IMCs) has rekindled interest in studying the characteristics, management and prognosis of IMCs and comparing them to T1 colorectal cancers (CRCs). METHODS: This population-based study included 282 cases of IMC and 207 cases of T1 CRC diagnosed by colonoscopy after a positive fecal blood test through a screening program. RESULTS: IMC presented mainly in the form of pedunculated polyps (68.4%) located in the distal colon (69.9%) with a size ≥20 mm (60.6%). IMCs were endoscopically resected in 227 (80.5%) patients and surgically resected in 55 (19.5%) patients. Surgical patients had more right-sided, more sessile, and larger lesions. There was no sign of lymphovascular invasion. Compared with T1 CRC, IMC demonstrated lower rates of sessile polyps (31.6% vs 49.8%, p<0.0001), primary and ultimate surgical treatment (19.5% vs 39.1% and 19.9% vs 78.7%, p<0.0001, respectively), lymph node metastasis in surgical patients (0% vs 9.5%, p=0.041), cancer recurrence and cancer-related mortality (0% vs 5.6% and 0% vs 2.5%, respectively), and bleeding after endoscopic resection (1.8% vs 8.7%, p=0.001). By multivariate analysis of the pooled cohort (IMC + T1 CRC, n=489), the factors significantly associated with first line surgery were shown to be polyp characteristics and the gastroenterologist having performed the colonoscopy. CONCLUSIONS: IMCs account for a quarter of all screen-detected CRC. They have an excellent prognosis regardless of whether endoscopic or surgical treatment is performed. IMCs differ significantly from T1 carcinomas in terms of management and prognosis. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/32590054/Reappraisal_of_the_characteristics,_management,_and_prognosis_of_intramucosal_colorectal_cancers_and_their_comparison_with_T1_carcinomas L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(20)34516-8 DB - PRIME DP - Unbound Medicine ER -
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