title: A scoring system basing pathological parameters to predict regional lymph node metastasis after preoperative chemoradiotherapy for locally advanced rectal cancer: implication for local excision.
abstract: Local excision is an alternative to radical surgery that is indicated in patients with locally advanced rectal cancer (LARC) who have a good response to chemoradiotherapy (CRT). Regional lymph node status is a major uncertainty during local excision of LARC following CRT. We retrospectively reviewed clinicopathologic variables for 244 patients with LARC who were treated at our institute between December 2000 and December 2013 in order to identify independent predictors of regional lymph node metastasis. Multivariate analysis of the training sample demonstrated that histopathologic type, tumor size, and the presence of lymphovascular invasion were significant predictors of regional nodal metastasis. These variables were then incorporated into a scoring system in which the total scores were calculated based on the points assigned for each parameter. The area under the curve in the receiver operating characteristic analysis was 0.750, and the cutoff value for the total score to predict regional nodal metastasis was 7.5. The sensitivity of our system was 73.2% and the specificity was 69.4%. The sensitivity was 77.8% and the specificity was 51.2% when the scoring system was applied to the testing sample. Using this system, we could accurately predict regional nodal metastases in LARC patients following CRT, which may be useful for stratifying patients in clinical trials and selecting potential candidates for organ-sparing surgery following CRT for LARC.
authors.affiliation: Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, People's Republic of China.
authors.forename: Xiao-Jie
authors.initials: XJ
authors.lastname: Wang
authors.affiliation: Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, People's Republic of China.
authors.forename: Pan
authors.initials: P
authors.lastname: Chi
authors.affiliation: Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, People's Republic of China.
authors.forename: Hui-Ming
authors.initials: HM
authors.lastname: Lin
authors.affiliation: Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, People's Republic of China.
authors.forename: Xing-Rong
authors.initials: XR
authors.lastname: Lu
authors.affiliation: Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, People's Republic of China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, People's Republic of China.
authors.forename: Zong-Bin
authors.initials: ZB
authors.lastname: Xu
authors.affiliation: Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, People's Republic of China.
authors.forename: Sheng-Hui
authors.initials: SH
authors.lastname: Huang
authors.affiliation: Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, People's Republic of China.
authors.forename: Yan-Wu
authors.initials: YW
authors.lastname: Sun
authors.affiliation: Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, People's Republic of China.
authors.forename: Dao-Xiong
authors.initials: DX
authors.lastname: Ye
authors.affiliation: Department of Pathology, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, People's Republic of China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D059186:Chemoradiotherapy, Adjuvant; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012004:Rectal Neoplasms / Q000473:pathology* / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: preoperative chemoradiotherapy; rectal cancer; regional nodal metastasis