Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China.
Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China.
Br J Cancer. 2020 Feb;122(3):388-396. doi: 10.1038/s41416-019-0671-7. Epub 2019 Dec 2.
Preoperative prediction of lymph node (LN) status is integral to determining the most appropriate treatment strategy for colorectal cancer (CRC). This study aimed to develop and validate a nomogram to predict LN metastasis in CRC preoperatively.
A total of 530 patients were enrolled and divided into training and validation cohorts. The tumour stroma percentage (TSP) of the preoperative biopsies was assessed. The risk factors for LN metastasis were selected, and a nomogram was constructed subsequently. The performance of the nomogram was assessed by using the AUROC and the calibration curve, and then validated in the validation cohort.
High TSP was significantly associated with LN metastasis in both the training and validation cohorts. Computed tomography (CT)-reported T stage, CT-reported LN status, preoperative tumour differentiation, carcinoembryonic antigen, carbohydrate antigen 19-9 and TSP were independent predictors of LN metastasis in CRC. A nomogram incorporating the six predictors was constructed. The nomogram yielded good discrimination and calibration, with an AUROC of 0.846 (95% CI: 0.807-0.886) and 0.809 (95% CI: 0.745-0.872) in the training and validation cohorts, respectively.
Assessment of TSP in the preoperative biopsies provided additional information about the LN status. The nomogram was useful for tailored therapy in CRC preoperatively.
术前预测淋巴结（LN）状态对于确定结直肠癌（CRC）的最佳治疗策略至关重要。本研究旨在开发和验证一种列线图，以便术前预测 CRC 的 LN 转移。
共纳入 530 例患者，并将其分为训练集和验证集。评估术前活检的肿瘤间质百分比（TSP）。选择 LN 转移的危险因素，并构建列线图。通过 AUROC 和校准曲线评估列线图的性能，然后在验证集中进行验证。
高 TSP 在训练集和验证集中均与 LN 转移显著相关。CT 报告的 T 分期、CT 报告的 LN 状态、术前肿瘤分化、癌胚抗原、糖类抗原 19-9 和 TSP 是 CRC 中 LN 转移的独立预测因素。构建了一个包含这六个预测因素的列线图。该列线图具有良好的判别和校准能力，在训练集和验证集中的 AUC 分别为 0.846（95%CI：0.807-0.886）和 0.809（95%CI：0.745-0.872）。
术前活检中 TSP 的评估提供了关于 LN 状态的额外信息。该列线图可用于术前对 CRC 进行个体化治疗。
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