PDF(Pubmed)
Abstract：
According to past and current literature, metastasis of the lymph nodes at the inferior mesenteric artery (IMA-LN), also known as 253LN of colorectal cancer has been seldom investigated. To date, there are still controversies on whether the 253LN need to be routinely cleaned. Using specific criteria, 347 patients who underwent radical resection for rectal cancer between April 2019 and July 2022 were selected for the study. Logistic regression was used to determine the likelihood that a patient may suffer 253LN metastasis, and a nomogram for 253LN metastasis subsequently developed. The c-index and calibration curve were used to evaluate precision and discrimination in the nomogram, and the appropriateness of the final nomogram for the clinical setting determined using decision curve analysis (DCA). 253LN metastases appeared in the pathological specimens of 29 (8.4%) of the selected patients. Logistic regression showed that preoperative parameters including serum carcinoembryonic antigen (CEA) value ( > 5 ng / ml, OR = 2.894, P = 0.023), distance from anal margin (> 9 cm, OR = 2.406, P = 0.045) and degree of differentiation (poor, OR = 9.712, P < 0.001) were significantly associated with 253LN metastasis. A nomogram to predict 253LN metastasis in rectal cancer was developed and showed considerable discrimination and good precision (c-index = 0.750). Furthermore, DCA confirmed that the nomogram has some feasibility for the clinical environment. Clinicopathological and radiological patient data can be pivotal for making surgical decisions relating to 253LN metastasis. A nomogram was developed using this data, providing an objective method that can significantly improve prognoses in colorectal cancer.
摘要：
根据过去和现在的文献，肠系膜下动脉淋巴结转移（IMA-LN），也称为253LN的结直肠癌很少被研究。迄今为止,关于253LN是否需要常规清洁仍存在争议。使用特定的标准，选择在2019年4月至2022年7月期间接受直肠癌根治术的347例患者进行研究。Logistic回归用于确定患者可能遭受253LN转移的可能性，随后出现253LN转移的列线图。c指数和校准曲线用于评估列线图中的精确度和区分度，以及使用决策曲线分析（DCA）确定的最终列线图对于临床设置的适当性。253LN转移出现在29例(8.4%)患者的病理标本中。Logistic回归显示术前参数包括血清癌胚抗原(CEA)值(>5ng/ml,OR=2.894，P=0.023），与肛门边缘的距离（>9厘米，OR=2.406，P=0.045）和分化程度（差，OR=9.712,P<0.001)与253LN转移显著相关。开发了预测直肠癌中253LN转移的列线图，并显示出相当大的区分度和良好的精度（c指数=0.750）。此外，DCA证实列线图对于临床环境具有一定的可行性。临床病理和放射学患者数据对于做出与253LN转移有关的手术决策至关重要。使用这些数据绘制了列线图，提供了一种可以显着改善结直肠癌预后的客观方法。
