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
Highlights
Local excision (LE) is an acceptable treatment for early-stage rectal cancer (T1) [1]
We found that tumor size was the strongest predictor of regional nodal metastasis, which had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 51.2%, 81.2%, 74.2%, and 60.2%, respectively (Table 4)
One of the major uncertainties when performing LE for locally advanced rectal cancer (LARC) following CRT is the status of regional lymph nodes
Summary
Local excision (LE) is an acceptable treatment for early-stage rectal cancer (T1) [1]. This organ-sparing surgery avoids a permanent stoma in patients who would otherwise require abdominoperineal resection (APR). Less is known about the incidence of metastatic lymph node involvement in locally advanced rectal cancer (LARC, cT3-4 Nx or cTx N+) following a good response of the primary tumor to neoadjuvant treatment. Park et al [4] reported that the risk of residual mesorectal lymph node metastasis was high despite a good response to neoadjuvant chemoradiotherapy (CRT) within the bowel wall: 20.8% among ypT2, 17.1% among ypT1, and 9.1% among ypT0 patients. No studies have demonstrated a relationship between the histopathologic features of the primary residual tumor and the metastatic status of regional lymph nodes
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