Risk Factors of Submucosal Invasion in Early Colorectal Cancer

Abstract Aim This study aimed to explore the risk factors of submucosal invasion in early colorectal cancer (ECC), so as to provide more accurate treatment strategies for ECC patients. Methods We retrospectively enrolled patients with ECC who received endoscopic or surgical treatment at the First Affiliated Hospital of Wannan Medical College, from January 2017 to December 2021. Univariate analysis and multivariate Logistic regression analysis were used to explore the risk factors of submucosal invasion in ECC. We used a receiver operating characteristic (ROC) curve to estimate the predictive value of independent risk factors for the risk of submucosal invasion in ECC. Results A total of 109 ECC patients were enrolled, among them, 46 cases (42.20%) with infiltration depth of submucosa were classified as the study group, and the remaining 63 cases without submucosal invasion were classified as the control group. Univariate analysis showed that age ≥ 65 years old, lesion diameter > 1cm, differentiation degree, lesion surface accompanied by erosion or ulceration, redness and bleeding tendency were associated with submucosal invasion of ECC (P < 0.05). Multivariate Logistic regression analysis showed that the moderate or poor differentiation (β = 4.158, odds ratio [OR] = 63.960, 95% confidence interval [CI]:15.149-270.038, P < 0.001), bleeding tendency (β = 2.828, OR = 16.914, 95%CI:1.728-165.553, P = 0.015) were independent risk factors for submucosal invasion with ECC. The area under the ROC curve (AUC) of differentiation degree was 0.871 (95%CI: 0.797–0.945, P < 0.001), the AUC of bleeding tendency was 0.582 (95%CI: 0.471–0.693, P = 0.145), and the AUC of the combined measurements was 0.906 (95%CI: 0.845–0.967, P < 0.001). Conclusion Moderate or poor differentiation and bleeding tendency are independent risk factors for submucosal invasion with ECC. The accuracy of combined measurements is higher than that of single measuremnet. Patients with ECC meeting the above conditions should be adequately evaluated before surgery, so as to provide more accurate treatment strategies.