A nomogram prediction model for lymph node metastasis risk after neoadjuvant chemoradiotherapy in rectal cancer patients based on SEER database

Xiaoshuang Liu; Li Sha; Cheng Huang; Xiancheng Kong; Feihu Yan; Xiaohui Shi; Xuefeng Tang

doi:10.3389/fonc.2023.1098087

A nomogram prediction model for lymph node metastasis risk after neoadjuvant chemoradiotherapy in rectal cancer patients based on SEER database

Front Oncol. 2023 Feb 27:13:1098087. doi: 10.3389/fonc.2023.1098087. eCollection 2023.

Authors

Xiaoshuang Liu^{1

2}, Li Sha¹, Cheng Huang², Xiancheng Kong¹, Feihu Yan², Xiaohui Shi², Xuefeng Tang¹

Affiliations

¹ Department of General Surgery, Shuguang Hospital, Shanghai University of traditional Chinese Medicine, Shanghai, China.
² Department of Colorectal Surgery, Shanghai Changhai Hospital, Shanghai, China.

Abstract

Background: Rectal cancer patients who received neoadjuvant chemoradiotherapy (CRT) may have a lower cancer stage and a better prognosis. Some patients may be able to avoid invasive surgery. It is critical to accurately assess lymph node metastases (LNM) after neoadjuvant chemoradiotherapy. The goal of this study is to identify clinical variables associated with LNM and to develop a nomogram for LNM prediction in rectal cancer patients following nCRT.

Methods: From 2010 to 2015, patients were drawn from the Surveillance, Epidemiology, and End Results (SEER) database. To identify clinical factors associated with LNM, the least absolute shrinkage and selection operator (LASSO) aggression and multivariate logistic regression analyses were used. To predict the likelihood of LNM, a nomogram based on multivariate logistic regression was created using decision curve analyses.

Reslut: The total number of patients included in this study was 6,388. The proportion of patients with pCR was 17.50% (n=1118), and the proportion of patients with primary tumor pCR was 20.84% (n = 1,331). The primary tumor was pCR in 16.00% (n=213) of the patients. Age, clinical T stage, clinical N stage, and histology were found to be significant independent clinical predictors of LNM using LASSO and multivariate logistic regression analysis. The nomogram was developed based on four clinical factors. The 5-year overall survival rate was 78.9 percent for those with ypN- and 66.3 percent for those with ypN+, respectively (P<0.001).

Conclusion: Patients over 60 years old, with clinical T1-2, clinical N0, and adenocarcinoma may be more likely to achieve ypN0. The watch-and-wait (WW) strategy may be considered. Patients who had ypN0 or pCR had a better prognosis.

Keywords: SEER; lymph node metastasis; neoadjuvant chemoradiotherapy (NACRT); nomogram; prediction model; rectal cancer (RC).

Grants and funding

The study was supported by Special clinical research project of health industry of Shanghai Municipal Health Commission, 20224Y0075. "Shanghai specialist capacity building project (ZY(2018-2020)-ZYBZ-07)". “Medicine New Star” of Shanghai, China, 202265. “Deep blue” talent project, “sailing program” funding of PLA Naval Military Medical University, 202128, Project establishment and cultivation of teaching achievements of Chang-Hai Hospital, PLA Naval Military Medical University, CHPY2021B15, and Youth program of Nat ional Natural Science Foundation of China, 81802434.