Liu Xiaoshuang, Sha Li, Huang Cheng, Kong Xiancheng, Yan Feihu, Shi Xiaohui, Tang Xuefeng
Department of General Surgery, Shuguang Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China.
Department of Colorectal Surgery, Shanghai Changhai Hospital, Shanghai, China.
Front Oncol. 2023 Feb 27;13:1098087. doi: 10.3389/fonc.2023.1098087. eCollection 2023.
Rectal cancer patients who received neoadjuvant chemoradiotherapy (CRT) may have a lower cancer stage and a better prognosis. Some patients may be able to avoid invasive surgery. It is critical to accurately assess lymph node metastases (LNM) after neoadjuvant chemoradiotherapy. The goal of this study is to identify clinical variables associated with LNM and to develop a nomogram for LNM prediction in rectal cancer patients following nCRT.
From 2010 to 2015, patients were drawn from the Surveillance, Epidemiology, and End Results (SEER) database. To identify clinical factors associated with LNM, the least absolute shrinkage and selection operator (LASSO) aggression and multivariate logistic regression analyses were used. To predict the likelihood of LNM, a nomogram based on multivariate logistic regression was created using decision curve analyses.
The total number of patients included in this study was 6,388. The proportion of patients with pCR was 17.50% (n=1118), and the proportion of patients with primary tumor pCR was 20.84% (n = 1,331). The primary tumor was pCR in 16.00% (n=213) of the patients. Age, clinical T stage, clinical N stage, and histology were found to be significant independent clinical predictors of LNM using LASSO and multivariate logistic regression analysis. The nomogram was developed based on four clinical factors. The 5-year overall survival rate was 78.9 percent for those with ypN- and 66.3 percent for those with ypN+, respectively (P<0.001).
Patients over 60 years old, with clinical T1-2, clinical N0, and adenocarcinoma may be more likely to achieve ypN0. The watch-and-wait (WW) strategy may be considered. Patients who had ypN0 or pCR had a better prognosis.
接受新辅助放化疗（CRT）的直肠癌患者可能癌症分期较低且预后较好。部分患者可能无需进行侵入性手术。准确评估新辅助放化疗后的淋巴结转移（LNM）至关重要。本研究的目的是确定与LNM相关的临床变量，并为接受nCRT后的直肠癌患者开发LNM预测列线图。
2010年至2015年期间，患者来自监测、流行病学和最终结果（SEER）数据库。为确定与LNM相关的临床因素，采用了最小绝对收缩和选择算子（LASSO）回归和多因素逻辑回归分析。为预测LNM的可能性，使用决策曲线分析创建了基于多因素逻辑回归的列线图。
本研究纳入的患者总数为6388例。病理完全缓解（pCR）患者的比例为17.50%（n = 1118），原发肿瘤pCR患者的比例为20.84%（n = 1331）。16.00%（n = 213）的患者原发肿瘤为pCR。使用LASSO和多因素逻辑回归分析发现，年龄、临床T分期、临床N分期和组织学是LNM的显著独立临床预测因素。列线图基于四个临床因素开发。ypN-患者的5年总生存率为78.9%，ypN+患者的5年总生存率为66.3%（P<0.001）。
60岁以上、临床T1-2、临床N0且为腺癌的患者可能更易达到ypN0。可考虑采用观察等待（WW）策略。达到ypN0或pCR的患者预后较好。
