Clinic of Colorectal and Minimally Invasive Surgery, Sechenov University, 1 Building 1 Pogodinskaya St, Moscow, Russia, 119435.
Department of General Surgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Int J Colorectal Dis. 2024 Sep 18;39(1):145. doi: 10.1007/s00384-024-04717-5.
The population in Western countries differs significantly from that in Eastern countries, and the prevalence of lateral pelvic lymph node (LPLN) involvement in Western populations remains largely unknown due to the limited application of LPLN dissection (LPLND). This discrepancy is primarily attributed to the higher body mass index commonly observed in Western populations, which increases the risk of intraoperative complications. Consequently, the aim of this study is to describe a specific Western clinico-radiological selection tool for LPLND, namely, the lateral pelvic lymph node positivity (LPLNP) score.
This retrospective single center study was designed to elaborate the LPLNP score, which was further tested on a prospective cohort of patients. Clinical and MRI factors associated with LPLN involvement were identified, and logistic regression was used to establish the LPLNP score.
In the retrospective series, 120 patients underwent lateral pelvic lymph node dissection. After stepwise logistic regression, five parameters were ultimately included in the LPLNP score. When tested on 66 prospectively selected patients, 40 with an LPLNP score > 0.23 (corresponding to the highest sensitivity and specificity) underwent LPLND: 22 patients (55%) had pathologically confirmed positive LPLN. The negative predictive value of the LPLNP score was 96%, with a sensitivity of 95.7% and a specificity of 58.1%.
The LPLNP score was developed based on the largest group of Western patients with locally advanced rectal cancer. This scoring system demonstrated high sensitivity and specificity during validation on the prospective series, correctly identifying LPLN involvement in 55% of cases.
西方国家的人群与东方国家存在显著差异，由于广泛应用侧方盆腔淋巴结清扫术（LPLND），西方国家人群中侧方盆腔淋巴结（LPLN）受累的发生率仍知之甚少。这种差异主要归因于西方国家人群中常见的较高体重指数，这增加了术中并发症的风险。因此，本研究旨在描述一种特定的西方临床放射选择工具用于 LPLND，即侧方盆腔淋巴结阳性（LPLNP）评分。
本回顾性单中心研究旨在详细阐述 LPLNP 评分，并在前瞻性患者队列中对其进行进一步测试。确定与 LPLN 受累相关的临床和 MRI 因素，并使用逻辑回归建立 LPLNP 评分。
在回顾性系列中，120 名患者接受了侧方盆腔淋巴结清扫术。经过逐步逻辑回归，最终有五个参数纳入 LPLNP 评分。在 66 名前瞻性选择的患者中进行测试时，40 名 LPLNP 评分＞0.23（对应最高的灵敏度和特异性）的患者接受了 LPLND：22 名患者（55%）LPLN 病理证实阳性。LPLNP 评分的阴性预测值为 96%，灵敏度为 95.7%，特异性为 58.1%。
LPLNP 评分是基于最大的一组局部晚期直肠癌西方患者开发的。该评分系统在前瞻性系列的验证中表现出了较高的灵敏度和特异性，正确识别了 55%的 LPLN 受累病例。
