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http://dx.doi.org/10.7314/APJCP.2013.14.11.6293

Pre-operative Predictive Factors for Intra-operative Pathological Lymph Node Metastasis in Rectal Cancers  

Gao, Chun (Department of Gastroenterology, China-Japan Friendship Hospital, Ministry of Health)
Li, Jing-Tao (Department of Gastroenterology, China-Japan Friendship Hospital, Ministry of Health)
Fang, Long (Department of Gastroenterology, China-Japan Friendship Hospital, Ministry of Health)
Wen, Si-Wei (Department of Gastroenterology, China-Japan Friendship Hospital, Ministry of Health)
Zhang, Lei (Department of Gastroenterology, China-Japan Friendship Hospital, Ministry of Health)
Zhao, Hong-Chuan (Department of Gastroenterology, China-Japan Friendship Hospital, Ministry of Health)
Publication Information
Asian Pacific Journal of Cancer Prevention / v.14, no.11, 2013 , pp. 6293-6299 More about this Journal
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 $bilirubin{\geq}2.60{\mu}mol/L$ (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 $bilirubin{\geq}2.60{\mu}mol/L$ were found to be associated with prognosis. Conclusion: Age, abdominal pain or discomfort, allergic history and direct bilirubin were associated with pLNM, which may be helpful for preoperative selection.
Keywords
Rectal cancer; lymph node metastasis; predictive factors; allergic history; direct bilirubin;
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1 Chang HC, Huang SC, Chen JS, et al (2012). Risk factors for lymph node metastasis in pT1 and pT2 rectal cancer: a single-institute experience in 943 patients and literature review. Ann Surg Oncol, 19, 2477-84.   DOI   ScienceOn
2 Chen Z, Liu Z, Deng X, et al (2012). Chromosomal copy number alterations are associated with persistent lymph node metastasis after chemoradiation in locally advanced rectal cancer. Dis Colon Rectum, 55, 677-85.   DOI
3 Ding PR, An X, Cao Y, et al (2011). Depth of tumor invasion independently predicts lymph node metastasis in T2 rectal cancer. J Gastrointest Surg, 15, 130-6.   DOI   ScienceOn
4 Fan XJ, Wan XB, Huang Y, et al (2012). Epithelial-mesenchymal transition biomarkers and support vector machine guided model in preoperatively predicting regional lymph node metastasis for rectal cancer. Br J Cancer, 106, 1735-41.   DOI   ScienceOn
5 Fujita S, Yamamoto S, Akasu T, et al (2009). Risk factors of lateral pelvic lymph node metastasis in advanced rectal cancer. Int J Colorectal Dis, 24, 1085-90.   DOI
6 Gao C, Fang L, Zhao HC, et al (2013). Potential role of diabetes mellitus in the progression of cirrhosis to hepatocellular carcinoma: a cross-sectional case-control study from Chinese patients with HBV infection. Hepatobiliary Pancreat Dis Int, 12, 385-93.   DOI   ScienceOn
7 Gosens MJ, van Krieken JH, Marijnen CA, et al (2007). Improvement of staging by combining tumor and treatment parameters: the value for prognostication in rectal cancer. Clin Gastroenterol Hepatol, 5, 997-1003.   DOI   ScienceOn
8 Group MS (2006). Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ, 333, 779.   DOI   ScienceOn
9 Saraste D, Gunnarsson U, Janson M (2013). Predicting lymph node metastases in early rectal cancer. Eur J Cancer, 49, 1104-8.   DOI   ScienceOn
10 Shin R, Jeong SY, Yoo HY, et al (2012). Depth of mesorectal extension has prognostic significance in patients with T3 rectal cancer. Dis Colon Rectum, 55, 1220-8.   DOI   ScienceOn
11 Singh R, Hellman S, Heimann R (2004). The natural history of breast carcinoma in the elderly: implications for screening and treatment. Cancer, 100, 1807-13.   DOI   ScienceOn
12 Tepper JE, O’Connell MJ, Niedzwiecki D, et al (2001). Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol, 19, 157-63.   DOI
13 Tsai CJ, Crane CH, Skibber JM, et al (2011). Number of lymph nodes examined and prognosis among pathologically lymph node-negative patients after preoperative chemoradiation therapy for rectal adenocarcinoma. Cancer, 117, 3713-22.   DOI   ScienceOn
14 Wu ZY, Wan J, Li JH, et al (2007). Prognostic value of lateral lymph node metastasis for advanced low rectal cancer. World J Gastroenterol, 13, 6048-52.   DOI
15 Yuhara H, Steinmaus C, Cohen SE, et al (2011). Is diabetes mellitus an independent risk factor for colon cancer and rectal cancer? Am J Gastroenterol, 106, 1911-21.   DOI   ScienceOn
16 Zhang H, Gao C, Fang L, et al (2013). Metformin and reduced risk of hepatocellular carcinoma in diabetic patients: a meta-analysis. Scand J Gastroenterol, 48, 78-87.   DOI   ScienceOn
17 Caywood J, Gray RJ, Hentz J, et al (2005). Older age independently predicts a lower risk of sentinel lymph node metastasis in breast cancer. Ann Surg Oncol, 12, 1061-5.   DOI
18 Bayar S, Saxena R, Emir B, et al (2002). Venous invasion may predict lymph node metastasis in early rectal cancer. Eur J Surg Oncol, 28, 413-7.   DOI   ScienceOn
19 Bipat S, Glas AS, Slors FJ, et al (2004). Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging--a meta-analysis. Radiology, 232, 773-83.   DOI   ScienceOn
20 Cai QC, Chen Y, Xiao Y, et al (2011). A prediction rule for estimating pancreatic cancer risk in chronic pancreatitis patients with focal pancreatic mass lesions with prior negative EUS-FNA cytology. Scand J Gastroenterol, 46, 464-70.   DOI   ScienceOn
21 Kim YW, Kim NK, Min BS, et al (2009). The influence of the number of retrieved lymph nodes on staging and survival in patients with stage II and III rectal cancer undergoing tumor-specific mesorectal excision. Ann Surg, 249, 965-72.   DOI   ScienceOn
22 Hoteit MA, Ghazale AH, Bain AJ, et al (2008). Model for end-stage liver disease score versus Child score in predicting the outcome of surgical procedures in patients with cirrhosis. World J Gastroenterol, 14, 1774-80.   DOI   ScienceOn
23 Ishida H, Hatano S, Ishiguro T, et al (2012). Prediction of lateral lymph node metastasis in lower rectal cancer: analysis of paraffin-embedded sections. Jpn J Clin Oncol, 42, 485-90.   DOI   ScienceOn
24 Kim JS, Sohn DK, Park JW, et al (2011). Prognostic significance of distribution of lymph node metastasis in advanced mid or low rectal cancer. J Surg Oncol, 104, 486-92.   DOI   ScienceOn
25 Lahaye MJ, Engelen SM, Nelemans PJ, et al (2005). Imaging for predicting the risk factors--the circumferential resection margin and nodal disease--of local recurrence in rectal cancer: a meta-analysis. Semin Ultrasound CT MR, 26, 259-68.   DOI   ScienceOn
26 Lambregts DM, Beets GL, Maas M, et al (2011). Accuracy of gadofosveset-enhanced MRI for nodal staging and restaging in rectal cancer. Ann Surg, 253, 539-45.   DOI   ScienceOn
27 Peng J, Wu H, Li X, et al (2013). Prognostic significance of apical lymph node metastasis in patients with node-positive rectal cancer. Colorectal Dis, 15, e13-20.   DOI   ScienceOn
28 Ricciardi R, Madoff RD, Rothenberger DA, et al (2006). Population-based analyses of lymph node metastases in colorectal cancer. Clin Gastroenterol Hepatol, 4, 1522-7.   DOI   ScienceOn