Zhang Hao, Wang Chunlin, Liu Yunxiao, Hu Hanqing, Wang Guiyu
Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Front Oncol. 2022 Jul 8;12:938996. doi: 10.3389/fonc.2022.938996. eCollection 2022.
The 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.
A 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 ( = 688) and a validation set ( = 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 () coefficients. The area under the receiver operating curve (AUC) was used to test model discrimination.
Preoperative 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.
The 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.
本研究旨在开发并验证一种术前评分系统，以对存在不同淋巴结检查不充分风险的直肠癌（RC）患者进行分层。
本回顾性研究纳入了2011年至2020年间哈尔滨医科大学附属第二医院的1375例I-III期RC患者，并将其随机分为开发集（n = 688）和验证集（n = 687）。采用逻辑回归模型确定导致淋巴结计数（LNC）< 12的独立因素。基于β（β）系数构建术前评分系统。采用受试者工作特征曲线（ROC）下面积（AUC）来检验模型的区分能力。
与LNC < 12相关的术前显著指标包括年龄、肿瘤大小、肿瘤位置和癌胚抗原（CEA）。开发集和验证集评分系统的AUC分别为0.694（95%CI = 0.648 - 0.741）和0.666（95%CI = 0.615 - 0.716）。评分0 - 2分、3 - 4分和5 - 6分的患者分别被分为低风险组、中风险组和高风险组。
术前评分系统能够准确识别淋巴结清扫不充分风险高的RC患者，并进一步为有针对性的患者进行术前淋巴结染色提供参考，以降低达到12枚淋巴结标准的难度，从而实现准确的肿瘤分期和良好的预后。
