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Establishing and validating predictive nomograms for lateral pelvic lymph node metastasis in patients with rectal cancer based on radiologic factors and clinicopathologic characteristics

  • Author Footnotes
    1 These authors contributed equally to this work.
    Sicheng Zhou
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Yingchi Yang
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center of Digestive Diseases, Beijing, 100050, China
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  • Zheng Lou
    Affiliations
    Department of Colorectal Surgery, The First Affiliated Hospital, Navy Medical University, Shanghai, 200433, China
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  • Jianwei Liang
    Affiliations
    Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
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  • Xin Wang
    Affiliations
    Department of General Surgery, Peking University First Hospital, Beijing, 100034, China
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  • Jianqiang Tang
    Correspondence
    Corresponding author. Jianqiang Tang, Jinyuan Road, Economic and Technological Development Zone, Guangyang District, 065000, Langfang.
    Affiliations
    Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China

    Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Hebei Cancer Hospital, Chinese Academy of Medical Sciences, Langfang, 065001, China
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  • Qian Liu
    Correspondence
    Corresponding author. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021.
    Affiliations
    Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
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  • on behalf ofthe Chinese Lateral Node Collaborative Group
  • Author Footnotes
    1 These authors contributed equally to this work.
Published:December 29, 2022DOI:https://doi.org/10.1016/j.ejso.2022.12.014

      Abstract

      Introduction

      It is critical to accurately predict the occurrence of lateral pelvic lymph node (LPN) metastasis. Currently, verified predictive tools are unavailable. This study aims to establish nomograms for predicting LPN metastasis in patients with rectal cancer who received or did not receive neoadjuvant chemoradiotherapy (nCRT).

      Materials and methods

      We carried out a retrospective study of patients with rectal cancer and clinical LPN metastasis who underwent total mesorectal excision (TME) and LPN dissection (LPND) from January 2012 to December 2019 at 3 institutions. We collected and evaluated their clinicopathologic and radiologic features, and constructed nomograms based on the multivariable logistic regression models.

      Results

      A total of 472 eligible patients were enrolled into the non-nCRT cohort (n = 312) and the nCRT cohort (n = 160). We established nomograms using variables from the multivariable logistic regression models in both cohorts. In the non-nCRT cohort, the variables included LPN short diameter, cT stage, cN stage, histologic grade, and malignant features, and the C-index was 0.930 in the training cohort and 0.913 in the validation cohort. In the nCRT cohort, the variables included post-nCRT LPN short diameter, ycT stage, ycN stage, histologic grade, and post-nCRT malignant features, and the C-index was 0.836 in the training dataset and 0.827 in the validation dataset. The nomograms in both cohorts were moderately calibrated and well-validated.

      Conclusions

      We established nomograms for patients with rectal cancer that accurately predict LPN metastasis. The performance of the nomograms in both cohorts was high and well-validated.

      Keywords

      Abbreviations:

      (LPN) (Lateral pelvic lymph node), (LPND) (Lateral pelvic lymph node dissection), (mrEMVI) (MRI-detected extramural venous invasion), (nCRT) (Neoadjuvant chemoradiotherapy), (TME) (Total mesorectal excision), (JSCCR) (Japanese Society for Cancer of the Colon and Rectum), (cCRM) (Clinical circumferential resection margin), (AJCC) (American Joint Committee on Cancer), (AV) (Anal verge), (ROC) (Receiver operating characteristics), (AUC) (Area under the curve)
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