Abstract Objectives This study evaluates risk factors for lymph node metastasis (LNM) in T2 colorectal cancer to refine patient selection for endoscopic resection. Methods We reviewed records from consecutive patients who had undergone curative surgical resection of T2 colorectal cancer at our institution in Japan between April 2001 and December 2021. Data on conventional clinicopathologic variables were retrieved from the pathology reports at the time of surgery. The clinicopathological features included patient age, sex, tumor diameter, morphology, tumor location, lymphatic invasion, vascular invasion, tumor differentiation, carcinoembryonic antigen and carbohydrate antigen 19‐9 levels, number of lymph node dissections, presence of adenoma component, and LNM. Results Among the patients (338 men, 320 women), 170 (25.8%) exhibited LNM. Multivariate logistic regression identified three independent risk factors for LNM: lymphatic invasion (odds ratio [OR], 32.6; 95% confidence interval [CI], 17.3–61.4; p < 0.0001), female sex (OR, 1.70; 95% CI, 1.10–2.62; p = 0.02), and elevated carcinoembryonic antigen levels (OR, 2.56; 95% CI, 1.10–5.96; p = 0.03). Conclusions Lymphatic invasion, female sex, and high carcinoembryonic antigen levels significantly increase the risk of LNM in T2 colorectal cancer.
