Adherence to National Quality Forum (NQF) colorectal cancer indicators among members of the Florida Initiative for Quality Cancer Care (FIQCC) consortium

6563 Background: FIQCC is a consortium of 10 institutions participating in a comprehensive practice-based system of quality self-assessment across a number of cancer types. The NQF has endorsed several performance measures to assess the quality of care for colorectal cancer (CRC) patients. We have sought to identify adherence to NQF CRC indicators among members of FIQCC. Methods: Comprehensive chart reviews were conducted for all patients with CRC first seen in 2006 by a medical oncologist at one of the 10 FIQCC sites (2 academic/8 community). NQF quality measures included: 1) consideration or administration of chemotherapy to patients with stage III colon cancer (CC); 2) completeness of pathology reporting for CRC; 3) >12 regional lymph nodes (LN) examined for resected CC. Statistical comparisons were performed using chi-squared analysis. Results: The population consisted of 475 patients (250 men and 225 women) with a median age of 65 years (range 27–92). Chemotherapy was considered/administered in 96.5% (136/141) of stage III CC patients. With respect to CRC pathologic reporting, there was strong compliance (>90%) for reporting the number of LN examined and involved by tumor, proximal/distal margin status, depth of invasion, and histologic grade. However, only 225 of 295 (76.2%) reports documented lymphovascular invasion status. Radial margin status was included for 45% (27/60) of surgical rectal cancer specimens. Only 73.9% (173/234) of CC cases had >12 LN examined. Of the NQF measures, significant differences across practice sites were noted for the reporting of histologic grade (p = 0.0002), proximal/distal margin status (p = 0.049), and lymphovascular invasion (p < 0.0001). Conclusions: Although there was uniformly strong adherence to the application of adjuvant therapy for stage III CC across FIQCC sites, the adequacy of lymphadenectomy and LN examination for resected CC was lower and varied considerably across sites. There remains room for improvement of pathologic CRC reporting across the whole consortium as well as at individual sites. The FIQCC initiative allows for the identification of targets for global quality improvement as well as of specific measures for individual institutions. No significant financial relationships to disclose.

Download Full-text

Retrospective analysis of LNM risk factors and the effect of chemotherapy in early colorectal cancer: A Chinese multicenter study

BMC Cancer ◽

10.1186/s12885-020-07363-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Chunyan Zeng ◽

Dandan Xiong ◽

Fei Cheng ◽

Qingtian Luo ◽

Qiang Wang ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Multicenter Study ◽

Tumor Size ◽

Lymphovascular Invasion ◽

Univariate Analysis ◽

Tumor Location ◽

Early Colorectal Cancer ◽

Depth Of Invasion ◽

Significant Difference

Abstract Background Estimating the risk of lymph node metastasis (LNM) is crucial for determining subsequent treatments following curative resection of early colorectal cancer (ECC). This multicenter study analyzed the risk factors of LNM and the effectiveness of postoperative chemotherapy in patients with ECC. Methods We retrospectively analyzed the data of 473 patients with ECC who underwent general surgery in five hospitals between January 2007 and October 2018. The correlations between LNM and sex, age, tumor size, tumor location, endoscopic morphology, pathology, depth of invasion and tumor budding (TB) were directly estimated based on postoperative pathological analysis. We also observed the overall survival (OS) and recurrence in ECC patients with and without LNM after matching according to baseline measures. Results In total, 473 ECC patients were observed, 288 patients were enrolled, and 17 patients had LNM (5.90%). The univariate analysis revealed that tumor size, pathology, and lymphovascular invasion were associated with LNM in ECC (P = 0.026, 0.000, and 0.000, respectively), and the multivariate logistic regression confirmed that tumor size, pathology, and lymphovascular invasion were risk factors for LNM (P = 0.021, 0.023, and 0.001, respectively). There were no significant differences in OS and recurrence between the ECC patients with and without LNM after matching based on baseline measures (P = 0.158 and 0.346, respectively), and no significant difference was observed between chemotherapy and no chemotherapy in ECC patients without LNM after surgery (P = 0.729 and 0.052). Conclusion Tumor size, pathology, and lymphovascular invasion are risk factors for predicting LNM in ECC patients. Adjuvant chemotherapy could improve OS and recurrence in patients with LNM but not always in ECC patients without LNM.

Download Full-text

Retrospective analysis for the LNM risk factors and effect of chemotherapy for the early colorectal cancer: A Chinese multicenter study

10.21203/rs.3.rs-25244/v5 ◽

2020 ◽

Author(s):

Chunyan Zeng ◽

Dandan Xiong ◽

Fei Cheng ◽

Qingtian Luo ◽

Qiang Wang ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Multicenter Study ◽

Tumor Size ◽

Lymphovascular Invasion ◽

Univariate Analysis ◽

Tumor Location ◽

Early Colorectal Cancer ◽

Depth Of Invasion ◽

Significant Difference

Abstract Background Estimating the risk of lymph node metastasis (LNM) is crucial for determining subsequent treatments following curative resection of early colorectal cancer (ECC). This multicenter study analyzed the risk factors of LNM and the effectiveness of postoperative chemotherapy in patients with ECC.Methods We retrospectively analyzed the data of 473 patients with ECC who underwent general surgery in five hospitals between January 2007 and October 2018. The correlations between LNM and sex, age, tumor size, tumor location, endoscopic morphology, pathology, depth of invasion and tumor budding (TB) were directly estimated based on postoperative pathological analysis. We also observed the overall survival (OS) and recurrence in ECC patients with and without LNM after matching according to baseline measures. Results In total, 473 ECC patients were observed, 288 patients were enrolled, and 17 patients had LNM (5.90%). The univariate analysis revealed that tumor size, pathology, and lymphovascular invasion were associated with LNM in ECC (P=0.026, 0.000, and 0.000, respectively), and the multivariate logistic regression confirmed that tumor size, pathology, and lymphovascular invasion were risk factors for LNM (P=0.021, 0.023, and 0.001, respectively). There were no significant differences in OS and recurrence between the ECC patients with and without LNM after matching based on baseline measures (P=0.158 and 0.346, respectively), and no significant difference was observed between chemotherapy and no chemotherapy in ECC patients without LNM after surgery (P=0.729 and 0.052).Conclusion Tumor size, pathology, and lymphovascular invasion are risk factors for predicting LNM in ECC patients. Adjuvant chemotherapy could improve OS and recurrence in patients with LNM but not always in ECC patients without LNM.

Download Full-text

Retrospective analysis for the LNM risk factors and effect of chemotherapy for the early colorectal cancer: A Chinese multicenter study

10.21203/rs.3.rs-25244/v3 ◽

2020 ◽

Author(s):

Chunyan Zeng ◽

Dandan Xiong ◽

Fei Cheng ◽

Qingtian Luo ◽

Qiang Wang ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Multicenter Study ◽

Tumor Size ◽

Lymphovascular Invasion ◽

Univariate Analysis ◽

Tumor Location ◽

Early Colorectal Cancer ◽

Depth Of Invasion ◽

Significant Difference

Abstract Background Estimating the risk of lymph node metastasis (LNM) is crucial for determining subsequent treatments following curative resection of early colorectal cancer (ECC). This multicenter study analyzed the risk factors of LNM and the effectiveness of postoperative chemotherapy in patients with ECC.Methods We retrospectively analyzed the data of 473 patients with ECC who underwent general surgery in five hospitals between January 2007 and October 2018. The correlations between LNM and sex, age, tumor size, tumor location, endoscopic morphology, pathology, depth of invasion and tumor budding (TB) were directly estimated based on postoperative pathological analysis. We also observed the overall survival (OS) and recurrence in ECC patients with and without LNM after matching according to baseline measures. Results In total, 473 ECC patients were observed, 288 patients were enrolled, and 17 patients had LNM (5.90%). The univariate analysis revealed that tumor size, pathology, and lymphovascular invasion were associated with LNM in ECC (P=0.026, 0.000, and 0.000, respectively), and the multivariate logistic regression confirmed that tumor size, pathology, and lymphovascular invasion were risk factors for LNM (P=0.021, 0.023, and 0.001, respectively). There were no significant differences in OS and recurrence between the ECC patients with and without LNM after matching based on baseline measures (P=0.158 and 0.346, respectively), and no significant difference was observed between chemotherapy and no chemotherapy in ECC patients without LNM after surgery (P=0.729 and 0.052).Conclusion Tumor size, pathology, and lymphovascular invasion are risk factors for predicting LNM in ECC patients. Adjuvant chemotherapy could improve OS and recurrence in patients with LNM but not always in ECC patients without LNM.

Download Full-text

Risk Factors for Metastasis to No.253 Lymph Node for Colorectal Cancer Patients

10.21203/rs.3.rs-97658/v1 ◽

2020 ◽

Author(s):

Zhouyuan Du ◽

Dianshi Wang ◽

Yuan Li ◽

Peng Hu ◽

Chuanqing Wu ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Lymph Node ◽

Lymph Nodes ◽

Lymphovascular Invasion ◽

Perineural Invasion ◽

Radical Resection ◽

Histologic Grade ◽

Tumor Type ◽

Lymph Nodes Metastasis

Abstract Background: No.253 lymph nodes metastasis is related to poor prognosis of colorectal cancer, while the role of No.253 lymph nodes dissection in colorectal cancer is still controversial.Methods: A total of 157 patients who were received laparoscopic radical resection of colorectal cancer with preservation of the left colon artery + D3 lymph node dissection (low ligation + high dissection) in our hospital were enrolled. No.253 lymph nodes of each patients were dissected and sent for examination. Clinicaopathological factors correlated with No.253 lymph nodes metastasis, including gender, age, tumor location, tumor size, length of tumor from the anus, whether lymphovascular invasion, whether perineural invasion, tumor markers CEA, CA125 and CA199, tumor T stage, whether it is distant metastasis, the total number of lymph nodes harvested, tumor type, and histologic grade were respectively analyzed.Results: A total of 2286 lymph nodes were sent for examination, of which 557 No.253 lymph nodes were sent for examination. Among them, 5 patients had a total of 27 No.253 lymph node metastases. Preoperative CA125 level (X2=4.736, p=0.030), whether perineural invasion (X2=8.086, p<0.01), whether lymphovascular invasion (X2= 7.053, p<0.01), tumor type (X2=21.019, p<0.01), histologic grade (X2=15.315, p<0.01) were significantly correlated with positive No.253 lymph nodes metastasis. A multivariate logistic regression analysis showed that none of risk factor from above are independent risk factors for No.253 lymph node metastasis(P>0.05).Conclusion: Preoperative CA125 level, whether perineural invasion, whether lymphovascular invasion, tumor type, histologic grade were risk factors of the No.253 lymph nodes metastasis. Multivariate analysis showed that five risk factors from above were not the independent risk factor for No.253 lymph nodes metastasis. Colorectal cancer patients with the risk factors above were suggested to receive radical resection + D3 lymph node dissection.

Download Full-text

Significant variation in histopathological assessment of endoscopic resections for Barrett's neoplasia suggests need for consensus reporting: propositions for improvement

Diseases of the Esophagus ◽

10.1093/dote/doab034 ◽

2021 ◽

Author(s):

M J van der Wel ◽

E Klaver ◽

R E Pouw ◽

L A A Brosens ◽

K Biermann ◽

...

Keyword(s):

Tumor Invasion ◽

Significant Variation ◽

Lymphovascular Invasion ◽

Margin Status ◽

Endoscopic Management ◽

Online Assessment ◽

Depth Of Invasion ◽

Histological Features ◽

Node Metastases ◽

Diagnostic Step

Abstract Endoscopic resection (ER) is an important diagnostic step in management of patients with early Barrett’s esophagus (BE) neoplasia. Based on ER specimens, an accurate histological diagnosis can be made, which guides further treatment. Based on depth of tumor invasion, differentiation grade, lymphovascular invasion, and margin status, the risk of lymph node metastases and local recurrence is judged to be low enough to justify endoscopic management, or high enough to warrant invasive surgical esophagectomy. Adequate assessment of these histological risk factors is therefore of the utmost importance. Aim of this study was to assess pathologist concordance on these histological features on ER specimens and evaluate causes of discrepancy. Of 62 challenging ER cases, one representative H&E slide and matching desmin and endothelial marker were digitalized and independently assessed by 13 dedicated GI pathologists from 8 Dutch BE expert centers, using an online assessment module. For each histological feature, concordance and discordance were calculated. Clinically relevant discordances were observed for all criteria. Grouping depth of invasion categories according to expanded endoscopic treatment criteria (T1a and T1sm1 vs. T1sm2/3), ≥1 pathologist was discrepant in 21% of cases, increasing to 45% when grouping diagnoses according to the traditional T1a versus T1b classification. For differentiation grade, lymphovascular invasion, and margin status, discordances were substantial with 27%, 42%, and 32% of cases having ≥1 discrepant pathologist, respectively. In conclusion, histological assessment of ER specimens of early BE cancer by dedicated GI pathologists shows significant discordances for all relevant histological features. We present propositions to improve definitions of diagnostic criteria.

Download Full-text

Loss of Villin Immunoexpression in Colorectal Carcinoma Is Associated with Poor Differentiation and Survival

ISRN Gastroenterology ◽

10.1155/2013/679724 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Jaudah Al-Maghrabi ◽

Wafaey Gomaa ◽

Abdelbaset Buhmeida ◽

Mohmmad Al-Qahtani ◽

Mahmoud Al-Ahwal

Keyword(s):

Lymphovascular Invasion ◽

Statistical Tests ◽

Tumour Size ◽

Disease Free Survival ◽

Nodal Metastasis ◽

Margin Status ◽

Depth Of Invasion ◽

Tumour Location

Background and Aims. Villin is a highly specialised protein and is expressed in intestinal and renal proximal tubular epithelium. It was detected in colorectal carcinomas (CRC) and other nongastrointestinal tumours. The aim of the current study is to investigate the immunohistochemical expression of villin in a subset of primary CRC and determine its relation to tumour differentiation, invasion, nodal metastasis, recurrence, and disease-free survival. Patients and Methods. Paraffin blocks of 93 cases of CRC were retrieved constituting 93 primary CRC and 58 adjacent normal mucosa. Immunohistochemistry was performed using antivillin antibody. The extent (%) of villin immunoexpression was categorised for statistical analysis. Statistical tests were used to determine the association of villin with clinicopathological characteristics: age, sex, tumour location, tumour size, depth of invasion, tumour grade, nodal metastasis, lymphovascular invasion, margin status, recurrence, and survival. Results. Villin immunostaining results showed that villin is downregulated in CRC. Villin has no association with age, sex, tumour location, depth of invasion, nodal metastasis, lymphovascular invasion, margin status, and recurrence. However, villin is expressed in higher rate in CRC less than 5 cm, well- and moderately differentiated CRC. Poor survival was associated with tumour with low villin immunoexpression. Conclusion. Villin was downregulated in CRC. Villin immunoexpression in CRC is associated with better survival, well-differentiated tumours, and small-sized tumours. Villin has no significant association with disease recurrence or nodal metastasis. More in vivo and in vitro studies are required for further elucidation of how villin may be involved in CRC.

Download Full-text

Predictive relevance of lymphovascular invasion in T1 colorectal cancer before endoscopic treatment

Endoscopy International Open ◽

10.1055/s-0043-117952 ◽

2017 ◽

Vol 05 (12) ◽

pp. E1278-E1283 ◽

Cited By ~ 3

Author(s):

Kazuya Inoki ◽

Taku Sakamoto ◽

Hiroyuki Takamaru ◽

Masau Sekiguchi ◽

Masayoshi Yamada ◽

...

Keyword(s):

Colorectal Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Endoscopic Treatment ◽

Lymphovascular Invasion ◽

Lesion Size ◽

Depth Of Invasion ◽

Predictive Risk Factor ◽

Node Metastasis ◽

Younger Age

Abstract Background and aim The depth of tumor invasion is currently the only reliable predictive risk factor for lymph node metastasis before endoscopic treatment for colorectal cancer. However, the most important factor to predict lymph node metastasis has been suggested to be lymphovascular invasion rather than the depth of invasion. Thus, the aim of this study was to investigate the predictive relevance of lymphovascular invasion before endoscopic treatment. Methods The data on pT1 colorectal cancers that were resected endoscopically or surgically from 2007 to 2015 were retrospectively reviewed. The cases were categorized into two groups: positive or negative for lymphovascular invasion. The following factors were evaluated by univariate and multivariate analyses: age and sex of the patients; location, size, and morphology of the lesion; and depth of invasion. Results The positive and negative groups included 229 and 457 cases, respectively. Younger age (P < 0.01), smaller lesion size (P = 0.01), non-LST (LST: laterally spreading tumor) (P < 0.01), presence of depression (P < 0.01), and pT1b (P < 0.01) were associated with lymphovascular invasion. In multivariate analysis, younger age (comparing patients aged ≤ 64 years with those aged > 65 years, OR, 1.81; 95 %CI, 1.29 – 2.53), presence of depression (OR, 1.97; CI, 1.40 – 2.77), non-LST features (OR, 1.50; CI, 1.04 – 2.15), and pT1b (OR, 3.08; CI, 1.91 – 4.97) were associated with lymphovascular invasion. Conclusion Younger age, presence of depression, T1b, and non-LST are associated with lymphovascular invasion. Therefore, careful pathological diagnosis and surveillance are necessary for lesions demonstrating any of these four factors.

Download Full-text

Retrospective analysis for the LNM risk factors and effect of chemotherapy for the early colorectal cancer: A Chinese multicenter study

10.21203/rs.3.rs-25244/v2 ◽

2020 ◽

Author(s):

Chunyan Zeng ◽

Dandan Xiong ◽

Fei Cheng ◽

Qingtian Luo ◽

Qiang Wang ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Multicenter Study ◽

Tumor Size ◽

Lymphovascular Invasion ◽

Univariate Analysis ◽

Tumor Location ◽

Early Colorectal Cancer ◽

Depth Of Invasion ◽

Significant Difference

Abstract Background Estimating the risk of lymph node metastasis (LNM) is crucial for determining subsequent treatments following curative resection of early colorectal cancer (ECC). This multicenter study analyzed the risk factors of LNM and the effectiveness of postoperative chemotherapy in patients with ECC.Methods We retrospectively analyzed the data of 473 patients with ECC who underwent general surgery in five hospitals between January 2007 and October 2018. The correlations between LNM and sex, age, tumor size, tumor location, endoscopic morphology, pathology, depth of invasion and tumor budding (TB) were directly estimated based on postoperative pathology results. We also observed the overall survival (OS) and recurrence in ECC patients with and without LNM after matching according to baseline measures. Results In total, 473 ECC patients were observed, 288 patients were enrolled, and 17 patients had LNM (5.90%). The univariate analysis revealed that tumor size, pathology, and lymphovascular invasion were associated with LNM in ECC (P=0.026, 0.000, and 0.000, respectively), and the multivariate logistic regression confirmed that tumor size, pathology, and lymphovascular invasion were risk factors for LNM (P=0.021, 0.023, and 0.001, respectively). There were no significant differences in OS and recurrence between the ECC patients with and without LNM after matching based on baseline measures (P=0.158 and 0.346, respectively), and no significant difference was observed between chemotherapy and no chemotherapy in ECC patients without LNM after surgery (P=0.729 and 0.052).Conclusion Tumor size, pathology, and lymphovascular invasion are risk factors for predicting LNM in ECC patients. Adjuvant chemotherapy could improve OS and recurrence in patients with LNM but not always in ECC patients without LNM.

Download Full-text

Retrospective analysis for the LNM risk factors and effect of chemotherapy for the early colorectal cancer: A Chinese multicenter study

10.21203/rs.3.rs-25244/v4 ◽

2020 ◽

Author(s):

Chunyan Zeng ◽

Dandan Xiong ◽

Fei Cheng ◽

Qingtian Luo ◽

Qiang Wang ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Multicenter Study ◽

Tumor Size ◽

Lymphovascular Invasion ◽

Univariate Analysis ◽

Tumor Location ◽

Early Colorectal Cancer ◽

Depth Of Invasion ◽

Significant Difference

Abstract Background Estimating the risk of lymph node metastasis (LNM) is crucial for determining subsequent treatments following curative resection of early colorectal cancer (ECC). This multicenter study analyzed the risk factors of LNM and the effectiveness of postoperative chemotherapy in patients with ECC.Methods We retrospectively analyzed the data of 473 patients with ECC who underwent general surgery in five hospitals between January 2007 and October 2018. The correlations between LNM and sex, age, tumor size, tumor location, endoscopic morphology, pathology, depth of invasion and tumor budding (TB) were directly estimated based on postoperative pathological analysis. We also observed the overall survival (OS) and recurrence in ECC patients with and without LNM after matching according to baseline measures. Results In total, 473 ECC patients were observed, 288 patients were enrolled, and 17 patients had LNM (5.90%). The univariate analysis revealed that tumor size, pathology, and lymphovascular invasion were associated with LNM in ECC (P=0.026, 0.000, and 0.000, respectively), and the multivariate logistic regression confirmed that tumor size, pathology, and lymphovascular invasion were risk factors for LNM (P=0.021, 0.023, and 0.001, respectively). There were no significant differences in OS and recurrence between the ECC patients with and without LNM after matching based on baseline measures (P=0.158 and 0.346, respectively), and no significant difference was observed between chemotherapy and no chemotherapy in ECC patients without LNM after surgery (P=0.729 and 0.052).Conclusion Tumor size, pathology, and lymphovascular invasion are risk factors for predicting LNM in ECC patients. Adjuvant chemotherapy could improve OS and recurrence in patients with LNM but not always in ECC patients without LNM.

Download Full-text