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. 2024 Jun 3;39(1):84.
doi: 10.1007/s00384-024-04653-4.

Prediction of lymph node metastasis in T1 colorectal cancer based on combination of body composition and vascular invasion

Shizhen Zhou #  1 , Qinggang Yuan #  2 , Lixiang Liu  3 , Kai Wang  4 , Ji Miao  1 , Hao Wang  1 , Chao Ding  5 , Wenxian Guan  6
Affiliations

Prediction of lymph node metastasis in T1 colorectal cancer based on combination of body composition and vascular invasion

Shizhen Zhou et al. Int J Colorectal Dis. .

Abstract

Objectives: Lymph node metastasis (LNM) in colorectal cancer (CRC) patients is not only associated with the tumor's local pathological characteristics but also with systemic factors. This study aims to assess the feasibility of using body composition and pathological features to predict LNM in early stage colorectal cancer (eCRC) patients.

Methods: A total of 192 patients with T1 CRC who underwent CT scans and surgical resection were retrospectively included in the study. The cross-sectional areas of skeletal muscle, subcutaneous fat, and visceral fat at the L3 vertebral body level in CT scans were measured using Image J software. Logistic regression analysis were conducted to identify the risk factors for LNM. The predictive accuracy and discriminative ability of the indicators were evaluated using receiver operating characteristic (ROC) curves. Delong test was applied to compare area under different ROC curves.

Results: LNM was observed in 32 out of 192 (16.7%) patients with eCRC. Multivariate analysis revealed that the ratio of skeletal muscle area to visceral fat area (SMA/VFA) (OR = 0.021, p = 0.007) and pathological indicators of vascular invasion (OR = 4.074, p = 0.020) were independent risk factors for LNM in eCRC patients. The AUROC for SMA/VFA was determined to be 0.740 (p < 0.001), while for vascular invasion, it was 0.641 (p = 0.012). Integrating both factors into a proposed predictive model resulted in an AUROC of 0.789 (p < 0.001), indicating a substantial improvement in predictive performance compared to relying on a single pathological indicator.

Conclusion: The combination of the SMA/VFA ratio and vascular invasion provides better prediction of LNM in eCRC.

Keywords: CT; Colorectal cancer; Skeletal muscle; Vascular invasion; Visceral fat.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The screening flowchart
Fig. 2
Fig. 2
Measurement of the cross-sectional areas of skeletal muscle and fat at the L3 vertebral body level in CT scans of CRC patients with (a) and without (b) LNM. An axial CT image segmented into the visceral fat area (VFA), subcutaneous fat area (SFA), and skeletal muscle area (SMA)
Fig. 3
Fig. 3
Distribution of SMA/VFA in LNM-positive and LNM-negative groups
Fig. 4
Fig. 4
The receiver operating characteristic curves for predicting lymphatic metastasis
See this image and copyright information in PMC

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