Study on the prediction model of lymph node metastasis and surgical strategy after non-curative endoscopic resection for locally early colorectal cancer
ZHAO Fu-qiang
LI Ji-yun
ZHANG Ming-guang
MEI Shi-wen
ZHAO Wei
HUANG Fei
XIAO Ti-xian
ZHENG Zhao-xu
LIU Qian
Abstract：Objective To develop a predictive model for lymph node metastasis after non-curative endoscopic resection for locally early colorectal cancer,investigate the approach and extent of lymph node dissection in subsequent surgeries.Methods A retrospective analysis was conducted based on the clinical and pathological data of 436 patients who underwent additional surgery after non-curative endoscopic resection for locally early colorectal cancer at the Cancer Hospital,Chinese Academy of Medical Sciences between 2014 and 2023.Binary Logistic regression analysis was used to identify factors influencing lymph node metastasis after non-curative endoscopic resection,and a nomogram was constructed.Results Pathological results after additional surgery indicated that 34 patients had lymph node metastasis.The positive lymph nodes were primarily located at the first and second stations,with 27 cases and 7 cases respectively,accounting for 6.2％and 1.6％of the total cohort.No metastasis was found at the third station.Tumor differentiation and specific case types(OR=0.236,95％CI 0.066-0.851,P=0.027),tumor invasion depth(OR=10.138,95％CI 2.107-48.781,P=0.004),vascular invasion(OR=9.980,95％CI 4.091-24.346,P＜0.001),and neural invasion(OR=7.776,95％CI 3.341-18.095,P＜0.001)were identified as independent risk factors for lymph node metastasis.The AUC for the nomogram prediction model in the training set was 0.870(95％CI 0.817-0.923),and the calibration curve demonstrated good consistency between the predicted and observed results.Conclusion Lymph node metastasis in locally early colorectal cancer is associated with tumor differentiation,specific pathological types,tumor invasion depth,vascular invasion,and neural invasion.For additional surgery following non-curative endoscopic resection,individualized surgical approach should be selected based on the location of the primary lesion,patients'preferences according,and standardized guidelines,balancing radicality and functional preservation,and the extent of lymph node dissection should be limited to the second station.
Keywords：locally early colorectal cancerendoscopenon-curative resectionadditional surgerylymph node metastasis
Publication Date：2024-07-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 793-797 )