A Preoperative Scoring System to Predict the Risk of Inadequate Lymph Node Count in Rectal Cancer

The aim of this study was to develop and validate a preoperative scoring system to stratify rectal cancer (RC) patients with different risks of inadequate lymph node examination.

A total of 1,375 stage I-III RC patients between 2011 and 2020 from the Second Affiliated Hospital of Harbin Medical University were included in the retrospective study and randomly divided into a development set (n = 688) and a validation set (n = 687). The logistic regression model was used to determine independent factors contributing to lymph node count (LNC) < 12. A preoperative scoring system was constructed based on beta (β) coefficients. The area under the receiver operating curve (AUC) was used to test model discrimination.

Preoperative significant indicators related to LNC < 12 included age, tumor size, tumor location, and CEA. The AUCs of the scoring system for development and validation sets were 0.694 (95% CI = 0.648-0.741) and 0.666 (95% CI = 0.615-0.716), respectively. Patients who scored 0-2, 3-4, and 5-6 were classified into the low-risk group, medium-risk group, and high-risk group, respectively.

The preoperative scoring system could identify RC patients with high risk of inadequate lymphadenectomy accurately and further provide a reference to perform preoperative lymph node staining in targeted patients to reduce the difficulty of meeting the 12-node standard, with the purpose of accurate tumor stage and favorable prognosis.