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Table 5 Cross-assessment of the same risk factors and risk predictors

From: Risk factors and risk prediction models for colorectal cancer metastasis and recurrence: an umbrella review of systematic reviews and meta-analyses of observational studies

Risk factor/risk predictor

Outcome evaluated in the umbrella review

Risk factor prevalence

Effect size (95% CI)a

Credibility assessment

Outcome in the risk prediction models

Effect size (95% CI)b

Model performance

CRC metastasis

Histopathological risk factor

  Vascular invasion

Lymph node metastasis in pT1 CRC

330/1731 = 19%

2.73 (1.98–3.78)

Convincing

Lymph node metastasis in pT1 CRC

8.45 (4.56–15.66)

AUC 0.812 (0.770–0.855); Hosmer–Lemeshow test: p = 0.737 (55)

Lymph node metastasis in rectal cancer

46/168 = 27%

5.86 (0.77–44.62)

No association

Lymph node metastasis in small rectal NETs treated by local excision

75/211 = 36%

3.63 (0.05–268.57)

No association

  Tumor budding

Lymph node metastasis in pT1 CRC

2401/10,128 = 24%

6.39 (5.23–7.80)

Highly suggestive

Lymph node metastasis in pT1 CRC

1.70 (1.03–2.80)

AUC 0.812 (0.770–0.855); Hosmer–Lemeshow test: p = 0.737 (55)

Lymph node metastasis in CRC

1955/6739 = 29%

4.96 (3.97–6.19)

Highly suggestive

  Tumor differentiation

Lymph node metastasis in pT1 CRC

94/2722 = 4%

5.61 (2.90–10.83)

Suggestive

Lymph node metastasis in pT1 CRC

11.77 (0.77–179.83)

AUC 0.90 (0.81–0.99) (49)

Lymph node metastasis in pT1 CRC patients who underwent additional surgeries after an endoscopic resection

122/209 = 58%

3.77 (1.12–123.16)

No association

Synchronous bone metastasis

1.69 (1.22–2.32)

AUC 0.903; sensitivity 0.851; specificity 0.845 (54)

  Submucosal invasion ≥ 1 mm

Lymph node metastasis in pT1 CRC

2389/2922 = 82%

2.95 (1.39–6.27)

Weak

Lymph node metastasis in pT1 CRC

2.14 (1.19–3.86)

AUC 0.812 (0.770–0.855); Hosmer–Lemeshow test: p = 0.737 (55)

  Tumor size > 1 cm

Lymph node metastasis in rectal cancer

203/348 = 58%

6.76 (3.25–14.04)

Highly suggestive

Peritoneal metastasis in colon cancer

1.04 (1.00–1.09)

ROC 0.753 (57)

Demographic risk factor

  Sex/gender

Lymph node metastasis in pT1 CRC

465/1329 = 35%

2.23 (0.78–6.42)

No association

Liver metastasis in CRC

NA

Sensitivity 0.74; specificity 0.62 (50)

Distant metastasis in CRC

1.40 (0.46–4.28)

AUC 0.80 (0.67–0.93); calibration plot (56)

CRC recurrence

Histopathological risk factor

  Vascular invasion (intramural)

Local recurrence in CRC

137/503 = 27%

1.55 (0.11–21.28)

No association

Overall recurrence in stage II CRC

1.30 (1.07–1.58)

C statistic 0.64; calibration plot (61)

  Vascular invasion (extramural)

Distant metastatic recurrence in rectal cancer

350/1262 = 28%

3.91 (2.61–5.86)

Highly suggestive

Overall recurrence in stage II colon cancer

2.48 (1.22–5.57)

C statistic 0.675; external C statistic 0.552 (68)

Anthropometric indices

  BMI (underweight)

Overall recurrence in CRC

2752/17,636 = 16%

1.13 (1.05–1.21)

Weak

Overall recurrence in stage III colon cancer

NA

C statistic 0.65; calibration plot (69)

  BMI (overweight)

Overall recurrence in CRC

13,225/28,109 = 47%

1.00 (0.96–1.05)

No association

  BMI (obese)

Overall recurrence in CRC

6362/21,246 = 30%

1.07 (1.02–1.13)

Weak

  1. Abbreviations: AUC area under the curve, BMI body mass index, CI confidence interval, CRC colorectal cancer, NA non-available
  2. aEffect size (95% CI), effect size from the umbrella review
  3. bEffect size (95% CI), effect size from the risk prediction models