Abstract
BackgroundPreoperative prediction of lymph node (LN) status is integral to determining the most appropriate treatment strategy for colorectal cancer (CRC). This study aimed to develop and validate a nomogram to predict LN metastasis in CRC preoperatively.MethodsA total of 530 patients were enrolled and divided into training and validation cohorts. The tumour stroma percentage (TSP) of the preoperative biopsies was assessed. The risk factors for LN metastasis were selected, and a nomogram was constructed subsequently. The performance of the nomogram was assessed by using the AUROC and the calibration curve, and then validated in the validation cohort.ResultsHigh TSP was significantly associated with LN metastasis in both the training and validation cohorts. Computed tomography (CT)-reported T stage, CT-reported LN status, preoperative tumour differentiation, carcinoembryonic antigen, carbohydrate antigen 19-9 and TSP were independent predictors of LN metastasis in CRC. A nomogram incorporating the six predictors was constructed. The nomogram yielded good discrimination and calibration, with an AUROC of 0.846 (95% CI: 0.807−0.886) and 0.809 (95% CI: 0.745−0.872) in the training and validation cohorts, respectively.ConclusionsAssessment of TSP in the preoperative biopsies provided additional information about the LN status. The nomogram was useful for tailored therapy in CRC preoperatively.
Highlights
Colorectal cancer (CRC) is the third most commonly occurring cancer and the second leading cause of cancer-related death globally.[1]
High tumour stroma percentage (TSP) was significantly associated with lymph node (LN) metastasis (P < 0.001), with an area under the receiver-operating characteristic curve (AUROC) of 0.740 in the training cohort (Table 1; Supplementary Fig. S2a)
This study investigated the role of TSP of the preoperative biopsies in predicting the LN status in colorectal cancer (CRC)
Summary
Colorectal cancer (CRC) is the third most commonly occurring cancer and the second leading cause of cancer-related death globally.[1]. Imaging modalities, including computed tomography (CT), are commonly used for evaluating the LN status in the clinic. Their overall accuracy in determining the LN status is oftentimes limited.[5,6,7] a robust biomarker is needed to improve the predictive performance of current strategies for LN metastasis preoperatively in patients with CRC. Computed tomography (CT)-reported T stage, CT-reported LN status, preoperative tumour differentiation, carcinoembryonic antigen, carbohydrate antigen 19-9 and TSP were independent predictors of LN metastasis in CRC. The nomogram yielded good discrimination and calibration, with an AUROC of 0.846 (95% CI: 0.807 −0.886) and 0.809 (95% CI: 0.745−0.872) in the training and validation cohorts, respectively. The nomogram was useful for tailored therapy in CRC preoperatively
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