title: Pre-operative predictive factors for intra-operative pathological lymph node metastasis in rectal cancers.
abstract: BACKGROUND
  A number of clinicopathologic factors have been found to be associated with pathological lymph node metastasis (pLNM) in rectal cancer; however, most of them can only be identified by expensive high resolution imaging or obtained after surgical treatment. Just like the Child-Turcotte-Pugh (CTP) and the model for end-stage liver disease (MELD) scores which have been widely used in clinical practice, our study was designed to assess the pre-operative factors which could be obtained easily to predict intra-operative pLNM in rectal cancer.
  
  
  METHODS
  A cohort of 469 patients who were treated at our hospital in the period from January 2003 to June 2011, and with a pathologically hospital discharge diagnosis of rectal cancer, were included. Clinical, laboratory and pathologic parameters were analyzed. A multivariate unconditional logistic regression model, areas under the curve (AUC), the Kaplan-Meier method (log-rank test) and the Cox regression model were used.
  
  
  RESULTS
  Of the 469 patients, 231 were diagnosed with pLNM (49.3%). Four variables were associated with pLNM by multivariate logistic analysis, age<60 yr (OR=1.819; 95% CI, 1.231-2.687; P=0.003), presence of abdominal pain or discomfort (OR=1.637; 95% CI, 1.052-2.547; P=0.029), absence of allergic history (OR=1.879; 95% CI, 1.041-3.392; P=0.036), and direct bilirubin ≥ 2.60 μmol/L (OR=1.540; 95% CI, 1.054-2.250; P=0.026). The combination of all 4 variables had the highest sensitivity (98.7%) for diagnostic performance. In addition, age<60 yr and direct bilirubin ≥ 2.60 μmol/L were found to be associated with prognosis.
  
  
  CONCLUSIONS
  Age, abdominal pain or discomfort, allergic history and direct bilirubin were associated with pLNM, which may be helpful for preoperative selection.
authors.affiliation: Department of Gastroenterology, China-Japan Friendship Hospital, Ministry of Health, Beijing, China E-mail : hongchuanzhao@hotmail.com, gaochun@bjmu.edu.cn.
authors.forename: Chun
authors.initials: C
authors.lastname: Gao
authors.forename: Jing-Tao
authors.initials: JT
authors.lastname: Li
authors.forename: Long
authors.initials: L
authors.lastname: Fang
authors.forename: Si-Wei
authors.initials: SW
authors.lastname: Wen
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.forename: Hong-Chuan
authors.initials: HC
authors.lastname: Zhao
mesh_terms: D058625:End Stage Liver Disease / Q000473:pathology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012004:Rectal Neoplasms / Q000473:pathology*; D012720:Severity of Illness Index