A Preoperative Scoring System to Predict the Risk of Inadequate Lymph Node Count in Rectal Cancer

Abstract

PurposeThe aim of this study was to develop and validate a preoperative scoring system to stratify rectal cancer (RC) patients with different risks of inadequate lymph node examination.MethodsA total of 1,375 stage I–III RC patients between 2011 and 2020 from the Second Affiliated Hospital of Harbin Medical University were included in the retrospective study and randomly divided into a development set (n = 688) and a validation set (n = 687). The logistic regression model was used to determine independent factors contributing to lymph node count (LNC) < 12. A preoperative scoring system was constructed based on beta (β) coefficients. The area under the receiver operating curve (AUC) was used to test model discrimination.ResultsPreoperative significant indicators related to LNC < 12 included age, tumor size, tumor location, and CEA. The AUCs of the scoring system for development and validation sets were 0.694 (95% CI = 0.648–0.741) and 0.666 (95% CI = 0.615–0.716), respectively. Patients who scored 0–2, 3–4, and 5–6 were classified into the low-risk group, medium-risk group, and high-risk group, respectively.ConclusionsThe preoperative scoring system could identify RC patients with high risk of inadequate lymphadenectomy accurately and further provide a reference to perform preoperative lymph node staining in targeted patients to reduce the difficulty of meeting the 12-node standard, with the purpose of accurate tumor stage and favorable prognosis.

Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis

“…Finally, 54 studies were included, with 30 included in the systematic review,5 19–47 and 24 in the meta-analysis (figure 1). 12–14 48–68…”

“…However, 18 articles indicated that more LNs were obtained from young patients than elderly patients (online supplemental table 6). 13 14 25 29 31 33 34 42 44 46 50 52 60–63 67 68 Five articles involving 16 184 patients with colorectal cancer included in the meta-analysis showed that fewer LNs were retrieved from elderly patients (aged≥65 years) than young patients (aged<65 years) (OR=0.70, 95% CI (0.54, 0.90), p = 0.005, I 2 =43.96%) (figure 2 and online supplemental figure 1). 12 51 53 59 66…”

“…12 14 52 55 56 60 66 Finally, 16 colorectal cancer studies that contained 125 269 patients also revealed that more LNs were obtained from females than males (OR=1.15, 95% CI (1.04 to 1.28), p=0.006, I 2 =67.06%) (figure 2 and online supplemental figure 3). 12–14 48 51–53 55 56 58 60 63 64 66–68…”

“…26 30 Furthermore, the meta-analysis including 7 studies with 34 351 patients revealed no significant differences in the overweight and obesity groups compared with the normal-weight group in colorectal cancer (OR=0.93, 95% CI (0.87 to 1.00), p=0.054, I 2 =0.00%) (figure 2 and online supplemental figure 4). 12 14 48 51 66–68…”

“…Ten articles revealed that more LNs could be obtained from the right colon than the other locations 21 22 25 29 31 37 39 41 44 48. As per the location of the tumour in the rectum, although three studies suggested that more LNs could be obtained from the upper rectum than the lower rectum,31 62 68 three studies found no significant association between rectal location and LN yield (online supplemental table 6). 23 38 42 The meta-analysis of eight studies containing 47 706 patients with colon cancer showed that fewer LNs were obtained from tumours located in the left colon than in the right colon (OR=0.43, 95% CI (0.33 to 0.56), p<0.001, I 2 =88.27%) (figure 3 and online supplemental figure 7).…”