Prediction of lateral pelvic lymph node metastasis from lower rectal cancer using magnetic resonance imaging and risk factors for metastasis: Multicenter study of the Lymph Node Committee of the Japanese Society for Cancer of the Colon and Rectum

International Journal of Colorectal Disease - Tập 32 - Trang 1479-1487 - 2017
Shimpei Ogawa1,2, Jin-ichi Hida3, Hideyuki Ike4, Tetsushi Kinugasa5, Mitsuyoshi Ota6, Eiji Shinto7, Michio Itabashi1, Takahiro Okamoto2, Masakazu Yamamoto1, Kenichi Sugihara8, Toshiaki Watanabe9
1Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University School of Medicine, Tokyo, Japan
2Department of Surgery II, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
3Department of Surgery, Kindai University School of Medicine, Osaka, Japan
4Department of Surgery, Saiseikai Yokohama City Nanbu Hospital, Yokohama, Japan
5Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan
6Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
7Department of Surgery, National Defense Medical College, Saitama, Japan
8Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
9Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan

Tóm tắt

The goal of the study was to examine prediction of lateral pelvic lymph node (LPLN) metastasis from lower rectal cancer using a logistic model including risk factors for LPLN metastasis and magnetic resonance imaging (MRI) clinical LPLN (cLPLN) status, compared to prediction based on MRI alone. The subjects were 272 patients with lower rectal cancer who underwent MRI prior to mesorectal excision combined with LPLN dissection (LPLD) at six institutes. No patients received neoadjuvant therapy. Prediction models for right and left pathological LPLN (pLPLN) metastasis were developed using cLPLN status, histopathological grade, and perirectal lymph node (PRLN) status. For evaluation, data for patients with left LPLD were substituted into the right-side equation and vice versa. Left LPLN metastasis was predicted using the right-side model with accuracy of 86.5%, sensitivity 56.4%, specificity 92.7%, positive predictive value (PPV) 61.1%, and negative predictive value (NPV) 91.2%, while these data using MRI cLPLN status alone were 80.4, 76.9, 81.2, 45.5, and 94.5%, respectively. Similarly, right LPLN metastasis was predicted using the left-side equation with accuracy of 83.8%, sensitivity 57.8%, specificity 90.4%, PPV 60.5%, and NPV 89.4%, and the equivalent data using MRI alone were 78.4, 68.9, 80.8, 47.7, and 91.1%, respectively. The AUCs for the right- and left-side equations were significantly higher than the equivalent AUCs for MRI cLPLN status alone. A logistic model including risk factors for LPLN metastasis and MRI findings had significantly better performance for prediction of LPLN metastasis compared with a model based on MRI findings alone.

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Thông tin xuất bản

International Journal of Colorectal Disease

Tập 32

1479-1487

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