Wang Yin, Zheng Sheng, Du Wenjie, Yang Juan, Mao Xiaozhou, Liu Tao, Zhang Qiuxin, Fu Zhipeng, Zhu Xing, Guo Yeli
Department of Gastroenterology, The People's Hospital of Bozhou, Bozhou, China.
Department of Gastroenterology, The Third People's Hospital of Yunnan Province, Kunming, China.
J Gastrointest Oncol. 2023 Apr 29;14(2):913-921. doi: 10.21037/jgo-23-125. Epub 2023 Apr 26.
Patients with T1 stage early colorectal cancer (CRC) can be treated with radical surgery or endoscopic surgery. Endoscopic surgery has a number of advantages, including minimal trauma and a rapid recovery. However, it cannot remove regional lymph nodes to assess whether there is lymph node metastasis. Thus, the analysis of the risk factors of lymph node metastasis in patients with T1 stage CRC is of great significance in the selection of appropriate treatment methods. Although previous studies have explored the risk factors for lymph node metastasis in T1 stage CRC patients, the number of cases were relatively insufficient, and further exploration is necessary.
A total of 2,085 patients who had been pathologically diagnosed with CRC from 2015 to 2017 from the Surveillance, Epidemiology, and End Results (SEER) database. Among the patients, 324 had lymph node metastasis. A multivariate logistic regression analysis was conducted to analyze the risk factors of lymph node metastasis in patients with T1 stage CRC. Next, we established a prediction model to predict lymph node metastasis in patients with T1 stage CRC.
The results of the multivariate logistic regression analysis showed that age at diagnosis, rectosigmoid cancer, poorly differentiated or undifferentiated tumor cells, and distant metastasis were independent factors of lymph node metastasis in patients with T1 stage CRC (P<0.05). This study used the R4.0.3 statistical software for the statistical analysis. The data set was randomly divided into a training set and verification set. The training set comprised 1,460 patients, and the verification set comprised 625 patients. The area under the receiver operating characteristic curve (AUC) of the training set was 0.675 [95% confidence interval (CI): 0.635-0.714], and the AUC of the verification set was 0.682 (95% CI: 0.617-0.747). In the validation set, the model was tested by the Hosmer-Lemeshow Goodness-of-Fit Test (χ=4.018, P=0.855), and the results showed that the model was reliable at predicting lymph node metastasis in patients with T1 stage CRC.
For CRC patients with high risk factors of lymph node metastasis, endoscopic physicians should carefully evaluate the advantages and disadvantages of the endoscopic surgery before deciding whether to perform this surgery.
T1期早期结直肠癌（CRC）患者可接受根治性手术或内镜手术治疗。内镜手术具有诸多优势，包括创伤极小且恢复迅速。然而，它无法切除区域淋巴结以评估是否存在淋巴结转移。因此，分析T1期CRC患者淋巴结转移的危险因素对于选择合适的治疗方法具有重要意义。尽管既往研究已探讨了T1期CRC患者淋巴结转移的危险因素，但病例数量相对不足，仍需进一步探索。
从监测、流行病学和最终结果（SEER）数据库中选取了2015年至2017年间经病理诊断为CRC的2085例患者。其中，324例有淋巴结转移。对T1期CRC患者淋巴结转移的危险因素进行多因素逻辑回归分析。接下来，我们建立了一个预测模型来预测T1期CRC患者的淋巴结转移情况。
多因素逻辑回归分析结果显示，诊断年龄、直肠乙状结肠癌、低分化或未分化肿瘤细胞以及远处转移是T1期CRC患者淋巴结转移的独立因素（P<0.05）。本研究使用R4.0.3统计软件进行统计分析。数据集被随机分为训练集和验证集。训练集包括1460例患者，验证集包括625例患者。训练集的受试者操作特征曲线（AUC）下面积为0.675 [95%置信区间（CI）：0.635 - 0.714]，验证集的AUC为0.682（95% CI：0.617 - 0.747）。在验证集中，该模型通过Hosmer-Lemeshow拟合优度检验进行测试（χ=4.018，P=0.855），结果表明该模型在预测T1期CRC患者淋巴结转移方面是可靠的。
对于具有淋巴结转移高危因素的CRC患者，内镜医师在决定是否进行内镜手术前应仔细评估内镜手术的利弊。
