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The important risk factor for lateral pelvic lymph node metastasis of lower rectal cancer is node-positive status on magnetic resonance imaging: study of the Lymph Node Committee of Japanese Society for Cancer of the Colon and Rectum

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

This study seeks to evaluate lateral pelvic lymph node (LPLN) and perirectal lymph node (PRLN) status on magnetic resonance imaging (MRI) as potential risk factors for lymph node metastasis.

Methods

The subjects were 394 patients with lower rectal cancer who underwent MRI prior to mesorectal excision (combined with lateral pelvic lymph node dissection in 272 patients) at 6 institutes. No patients received neoadjuvant therapy. Cases were classified as cN(+) and cN(−) based on the short axis of the largest lymph node ≥5 and <5 mm, respectively. LPLN and PRLN status and other clinicopathologic factors were analyzed by multivariate logistic regression. The importance of identified risk factors for lymph node metastasis was examined using the area under the curve (AUC).

Results

Independent risk factors for right LPLN metastasis included histopathological grade (G3 + G4), pPRLN(+), M1, cLPLN(+) [odds ratio (OR) 10.73, 95 % confidence interval (CI) 4.59–27.1], and those for left LPLN metastasis were age (<64), histopathological grade (G3 + G4), pPRLN(+), and cLPLN(+) (OR 24.53, 95 % CI 9.16–77.7). ORs for cLPLN(+) were highest. The AUCs for right and left cLPLN status of 0.7484 (95 % CI 0.6672–0.8153) and 0.7904 (95 % CI 0.7088–0.8538), respectively, were significantly higher than those for other risk factors. In contrast, the ORs for cPRLN(+) and cPRLN status of 2.46 (95 % CI 1.47–4.18) and 0.6396 (95 % CI 0.5917–0.6848) were not much higher than for other factors.

Conclusions

An LPLN-positive status with a short axis ≥5 mm on MRI is an important predictor of LPLN metastasis, but PRLN status is not a strong predictor of PRLN metastasis.

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Acknowledgments

This work was supported by the JSCCR.

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Authors and Affiliations

  1. Department of Surgery II, Tokyo Women’s Medical University School of Medicine, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Shimpei Ogawa & Takahiro Okamoto

  2. Department of Surgery, Kindai University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan

    Jin-ichi Hida

  3. Department of Surgery, Saiseikai Yokohama City Nanbu Hospital, 3-2-10, Kounandai, Kounan-ku, Yokohama, Kanagawa, 234-8503, Japan

    Hideyuki Ike

  4. Department of Surgery, Kurume University School of Medicine, Asahimachi 67 Kurume City, Fukuoka, 830-0011, Japan

    Tetsushi Kinugasa

  5. Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan

    Mitsuyoshi Ota

  6. Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan

    Eiji Shinto

  7. Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University School of Medicine, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Michio Itabashi

  8. Department of Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Kenichi Sugihara

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  1. Shimpei Ogawa
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  2. Jin-ichi Hida
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  3. Hideyuki Ike
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Corresponding author

Correspondence to Jin-ichi Hida.

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The authors declare that they have no conflict of interest.

For this type of study formal consent is not required.

This article does not contain any studies with animals performed by any of the authors.

Informed consent was obtained from all individual participants included in the study.

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Ogawa, S., Hida, Ji., Ike, H. et al. The important risk factor for lateral pelvic lymph node metastasis of lower rectal cancer is node-positive status on magnetic resonance imaging: study of the Lymph Node Committee of Japanese Society for Cancer of the Colon and Rectum. Int J Colorectal Dis 31, 1719–1728 (2016). https://doi.org/10.1007/s00384-016-2641-3

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  • DOI: https://doi.org/10.1007/s00384-016-2641-3

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