Abstract
ObjectiveThis study aimed to develop a dual-energy spectral computed tomography (DESCT) nomogram that incorporated both clinical factors and DESCT parameters for individual preoperative prediction of lymph node metastasis (LNM) in patients with colorectal cancer (CRC).Material and MethodsWe retrospectively reviewed 167 pathologically confirmed patients with CRC who underwent enhanced DESCT preoperatively, and these patients were categorized into training (n = 117) and validation cohorts (n = 50). The monochromatic CT value, iodine concentration value (IC), and effective atomic number (Eff-Z) of the primary tumors were measured independently in the arterial phase (AP) and venous phase (VP) by two radiologists. DESCT parameters together with clinical factors were input into the prediction model for predicting LNM in patients with CRC. Logistic regression analyses were performed to screen for significant predictors of LNM, and these predictors were presented as an easy-to-use nomogram. The receiver operating characteristic curve and decision curve analysis (DCA) were used to evaluate the clinical usefulness of the nomogram.ResultsThe logistic regression analysis showed that carcinoembryonic antigen, carbohydrate antigen 199, pericolorectal fat invasion, ICAP, ICVP, and Eff-ZVP were independent predictors in the predictive model. Based on these predictors, a quantitative nomogram was developed to predict individual LNM probability. The area under the curve (AUC) values of the nomogram were 0.876 in the training cohort and 0.852 in the validation cohort, respectively. DCA showed that our nomogram has outstanding clinical utility.ConclusionsThis study presents a clinical nomogram that incorporates clinical factors and DESCT parameters and can potentially be used as a clinical tool for individual preoperative prediction of LNM in patients with CRC.
Highlights
According to the latest global cancer statistics, colorectal cancer (CRC) is ranked among the top three cancers in terms of both prevalence and mortality, and its incidence is increasing [1]
We retrospectively evaluated all patients seen at our hospital between February 2015 and November 2019; eligible patients were those with pathologically confirmed CRC who underwent curative resection with lymph node (LN) dissection and who had received abdominal enhanced dual-energy spectral computed tomography (DESCT) imaging before surgery
The training cohort was used for model building, while the validation cohort was used for internal validation of the model
Summary
According to the latest global cancer statistics, colorectal cancer (CRC) is ranked among the top three cancers in terms of both prevalence and mortality, and its incidence is increasing [1]. Accurate preoperative evaluation of lymph node metastasis (LNM) is critical to making a precise treatment plan and evaluating patient prognosis [2, 3]. Histopathological features such as tumor differentiation and lymphatic invasion are closely related to LNM, these features are only available postoperatively and provide limited clinical guidance [4]. Non-invasive radiological modalities, such as CT, magnetic resonance imaging, and endoluminal ultrasonography, have been widely utilized in the evaluation of LNM in clinical practice. Developing more sensitive diagnostic tools for the preoperative prediction of LNM in patients with CRC patients is imperative
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