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Pre-operative Predictive Factors for Intra-operative Pathological Lymph Node Metastasis in Rectal Cancers

  • Gao, Chun (Department of Gastroenterology, China-Japan Friendship Hospital, Ministry of Health) ;
  • Li, Jing-Tao (Department of Gastroenterology, China-Japan Friendship Hospital, Ministry of Health) ;
  • Fang, Long (Department of Gastroenterology, China-Japan Friendship Hospital, Ministry of Health) ;
  • Wen, Si-Wei (Department of Gastroenterology, China-Japan Friendship Hospital, Ministry of Health) ;
  • Zhang, Lei (Department of Gastroenterology, China-Japan Friendship Hospital, Ministry of Health) ;
  • Zhao, Hong-Chuan (Department of Gastroenterology, China-Japan Friendship Hospital, Ministry of Health)
  • Published : 2013.11.30

Abstract

Background: A number of clinicopathologic factors have been found to be associated with pathological lymph node metastasis (pLNM) in rectal cancer; however, most of them can only be identified by expensive high resolution imaging or obtained after surgical treatment. Just like the Child-Turcotte-Pugh (CTP) and the model for end-stage liver disease (MELD) scores which have been widely used in clinical practice, our study was designed to assess the pre-operative factors which could be obtained easily to predict intra-operative pLNM in rectal cancer. Methods: A cohort of 469 patients who were treated at our hospital in the period from January 2003 to June 2011, and with a pathologically hospital discharge diagnosis of rectal cancer, were included. Clinical, laboratory and pathologic parameters were analyzed. A multivariate unconditional logistic regression model, areas under the curve (AUC), the Kaplan-Meier method (log-rank test) and the Cox regression model were used. Results: Of the 469 patients, 231 were diagnosed with pLNM (49.3%). Four variables were associated with pLNM by multivariate logistic analysis, age<60 yr (OR=1.819; 95% CI, 1.231-2.687; P=0.003), presence of abdominal pain or discomfort (OR=1.637; 95% CI, 1.052-2.547; P=0.029), absence of allergic history (OR=1.879; 95% CI, 1.041-3.392; P=0.036), and direct $bilirubin{\geq}2.60{\mu}mol/L$ (OR=1.540; 95% CI, 1.054-2.250; P=0.026). The combination of all 4 variables had the highest sensitivity (98.7%) for diagnostic performance. In addition, age<60 yr and direct $bilirubin{\geq}2.60{\mu}mol/L$ were found to be associated with prognosis. Conclusion: Age, abdominal pain or discomfort, allergic history and direct bilirubin were associated with pLNM, which may be helpful for preoperative selection.

Keywords

Rectal cancer;lymph node metastasis;predictive factors;allergic history;direct bilirubin

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