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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