title: A scoring system to predict inferior mesenteric artery lymph node metastasis and prognostic value of its involvement in rectal cancer.
abstract: OBJECTIVE
  The aim of this study is to establish a prediction scoring system for inferior mesenteric artery (IMA) lymph node metastasis and to assess the prognostic impact of dissection of positive IMA node on patients with stage III rectal cancer.
  
  
  METHODS
  A retrospective study was performed in 264 patients with stage III rectal cancer undergoing curative surgery. Clinicopathological, survival, and recurrence data were compared between 29 patients with positive IMA nodes and 235 patients with negative IMA nodes. Clinicopathological data which were found to be significantly associated with IMA nodal status were incorporated into a scoring system.
  
  
  RESULTS
  In the training samples, tumor differentiation and preoperative serum CEA were significant predictors of IMA node metastasis in multivariate analysis, which were incorporated into a scoring system. Using receiver operating characteristic curve analysis, we determined a cutoff value of 46.5 for scores, at which the system's sensitivity was 86 % and specificity 61 %. When applied to testing sample, the sensitivity was 80 % and specificity 60 %. Survival analysis showed that 5-year disease-free survival rate (5-DFS) and 5-year overall survival (5-OS) in the positive IMA node group (24.4 and 27.6 %, respectively) were significantly lower than in the negative IMA node group (61.8 and 71.3 %, respectively) (P < 0.001). Furthermore, multivariate analysis indicated that IMA lymph node metastasis was an unfavorable independent prognostic factor for 5-DFS and 5-OS.
  
  
  CONCLUSIONS
  IMA lymph node metastasis is an independent poor prognostic factor for stage III rectal cancer. The prediction scoring system for IMA node metastasis would be beneficial in determining the appropriate level of IMA ligation.
authors: Department of Colorectal Surgery, Union Hospital, Fujian Medical University, 29 Xin-Quan Road, Fuzhou, Fujian, 350001, People's Republic of China.
authors: Xiao-Jie
authors: XJ
authors: Wang
authors: Pan
authors: P
authors: Chi
authors: Hui-Ming
authors: HM
authors: Lin
authors: Xing-Rong
authors: XR
authors: Lu
authors: Ying
authors: Y
authors: Huang
authors: Zong-Bin
authors: ZB
authors: Xu
authors: Sheng-Hui
authors: SH
authors: Huang
authors: Yan-Wu
authors: YW
authors: Sun
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D002288:Adenocarcinoma, Mucinous / Q000401:mortality / Q000473:pathology / Q000601:surgery; D002272:Carcinoembryonic Antigen / Q000097:blood; D018279:Carcinoma, Signet Ring Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008026:Ligation; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012372:ROC Curve; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D012008:Recurrence; D012044:Regression Analysis; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D002272:Carcinoembryonic Antigen