Clinical and pathological features of advanced rectal cancer with submesenteric root lymph node metastasis: Meta-analysis

Abstract

Background: Advanced rectal cancer with submesenteric lymph node metastasis is a common complication of advanced rectal cancer, which has an important impact on the treatment and prognosis of patients.

Aim: To investigate the clinical and pathological characteristics of inferior mesenteric artery (IMA) root lymph node metastases in patients with rectal cancer. The findings of this study provided us with fresh medical information that assisted us in determining the appropriate treatment for these patients.

Methods: Our study searched PubMed, Google Scholar, and other databases and searched the relevant studies and reports on the risk factors of IMA root lymph node metastasis of rectal cancer published in the self-built database until December 31, 2023. After data extraction, the Newcastle-Ottawa scale was used to evaluate the quality of the included literature, and RevMan5.3 software was used for meta-analysis and heterogeneity testing. The fixed effect modules without heterogeneity were selected to combine the effect size, and the random effect modules with heterogeneity were selected to combine the effect size. The cause of heterogeneity was found through sensitivity analysis, and the data of various risk factors were combined to obtain the final effect size, odds ratio (OR) value, and 95% confidence interval (CI). Publication bias was tested by drawing funnel plots.

Results: A total of seven literature were included in this study. By combining the OR value of logistic multivariate regression and the 95%CI of various risk factors, we concluded that the risk factors for lymph node metastasis in the IMA region of rectal cancer were as follows: Preoperative carcinoembryonic antigen (CEA) > 5 ng/mL (OR = 0.32, 95%CI: 0.18-0.55, P < 0.05), tumor located above peritoneal reflexive (OR = 3.10, 95%CI: 1.78-5.42, P < 0.05), tumor size ≥ 5 cm (OR = 0.36, 95%CI: 0.22-0.57, P < 0.05), pathological type (mucinous adenocarcinoma/sig-ring cell carcinoma) (OR = 0.23, 95%CI: 0.13-0.41, P < 0.05), degree of tumor differentiation (low differentiation) (OR = 0.17, 95%CI: 0.10-0.31, P < 0.05), tumor stage (T3-4 stage) (OR = 0.11, 95%CI: 0.04-0.26, P < 0.05), gender and age were not risk factors for IMA root lymph node metastasis in rectal cancer (P > 0.05).

Conclusion: Preoperative CEA level, tumor location, tumor size, tumor pathologic type, tumor differentiation, and T stage were correlated with IMA root lymph node metastasis.

Keywords: Inferior mesenteric artery root lymph node metastasis; Meta-analysis; Rectal cancer; Risk factors; Survival prognosis.

Figure 1

Document retrieval flow chart. ¹Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databases/registers). ²If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools.

Figure 2

Meta-analysis. A: Meta-analysis of gender as a risk factor; B: Meta-analysis of age as a risk factor; C: Meta-analysis of preoperative carcinoembryonic antigen level as a risk factor; D: Meta-analysis of tumor location as a risk factor; E: Meta-analysis of tumor size as a risk factor; F: Meta-analysis of pathological types as risk factors; G: Meta-analysis of tumor differentiation degree as a risk factor; H: Meta-analysis of T stage as a risk factor. CI: Confidence interval; CEA: Carcinoembryonic antigen.

Figure 3

A biased funnel plot analysis. A: Biased funnel plot of gender as a risk factor; B: Biased funnel plot of age as a risk factor. OR: Odds ratio.