Analysis of risk factors for lymph node metastasis in pT1 colorectal cancer
Objective To investigate the risk factors of lymph node metastasis(LNM)in pT1 colorectal cancer(CRC).Methods A total of 342 patients who underwent primary local resection+secondary remedial radical resection or one-time radical resection in Ningbo Medical Center Lihuili Hospital from January 2017 to June 2023 and were confirmed as stage pT1 CRC by postoperative pathological examination were retrospectively selected as the study objects,among which 148 patients received primary local resection+secondary remedial radical resection.Multivariate logistic regression model was used to analyze the independent influencing factors of LNM in stage pT1 CRC patients and CRC patients receiving primary local resection+secondary remedial radical resection,and to construct and verify the LNM risk prediction model for stage pT1 CRC patients.The 5-year overall survival rate was compared between LNM-positive and LNM-negative patients.Results The LNM rate in patients with pT1 CRC was 13.2％(45/342),enlarged lymph node diameter＞5 mm(OR=6.751),histological poor differentiation(OR=4.439)and lymphovascular invasion(OR=10.395)were independent risk factors for LNM in pT1 CRC(all P＜0.05).The LNM rate of CRC patients who underwent primary local resection+remedial radical resection was 11.5％(17/148),female sex(OR=4.274,P=0.023)was an independent risk factor for LNM,while deep submucosal invasion(DSI)was not independently associated with the risk of LNM(P=0.067).There were no significant differences in overall 5-year survival rate between LNM-positive and LNM-negative patients(94.0％vs.98.0％,P=0.681).Based on five factors(enlarged lymph node diameter,tumor location,tissue differentiation stage,mucinous adenocarcinoma,lymphovascular invasion),a prediction nomogram model for LNM risk in pT1 CRC patients was constructed,the C index of the model was 0.808,and its overall correct prediction rate was 90.6％.Conclusion A prediction nomogram model for LNM risk has been developed based on the risk factors(enlarged lymph node diameter,tumor location,tissue differentiation stage,mucinous adenocarcinoma,lymphovascular invasion),which may provide some help in the subsequent treatment of CRC patients undergoing primary local resection.The study also indicates that DSI may not be an independent risk factor for LNM in pT1 CRC patients.
万方数据
维普
