Preoperative factors predicting lymphatic infiltration in colorectal cancer

Öz

Abstract Colorectal cancer (CRC) is one of the most common malignancies worldwide, and accurate preoperative staging is essential for optimal surgical planning and oncologic outcomes. Lymph node (LN) metastasis is a key prognostic factor in CRC and plays a decisive role in treatment selection. The aim of this study was to evaluate the predictive value of preoperative imaging findings and laboratory parameters for LN metastasis in patients with CRC, in light of current literature. We retrospectively analyzed patients who underwent surgery for CRC between January 2015 and January 2021. Demographic data, tumor characteristics, preoperative laboratory results, and imaging findings obtained by computed tomography (CT) and magnetic resonance imaging (MRI) were reviewed. Postoperative pathological LN status was used as the reference standard, and all variables were statistically analyzed to identify factors associated with LN metastasis. A total of 410 patients were included in the study, of whom 58.3% were male. Lymph node metastasis was absent in 235 patients (N0), while 137 patients were classified as N1 and 38 as N2. Elevated preoperative carcinoembryonic antigen (CEA) levels (>5 ng/mL) were significantly associated with advanced nodal stage, with a higher proportion of N2 disease (p<0.05). Among tumor-related factors, lymphovascular invasion and neural invasion were found to be significantly associated with LN metastasis (p<0.05). The sensitivity, specificity, positive predictive value, and negative predictive value of CT in detecting LN metastasis were 58.19%, 55.49%, 47.97%, and 65.30%, respectively. In conclusion, LN metastasis should be strongly considered in CRC patients with elevated preoperative CEA levels and the presence of lymphovascular or neural invasion, particularly when supported by CT findings. These parameters may assist surgeons in preoperative risk stratification and treatment planning.

Anahtar Kelimeler

• Colorectal Surgery;
• Lymph Node Dissection
• Lymph Node Metastasis
• Preoperative Assessment
• Surgical Oncology

Kolorektal kanserlerde lenfatik infiltrasyonu öngörmede preoperatif faktörler

Öz

Giriş ve amaç Tüm dünyada ensık görülen kanser türlerinden olan kolorektal kanser (KRK) tedavisinde erken tanı ve tanı aşmasında evrelemenin doğru yapılabilmesi, tedavi kararı ve başarısı açısından önemlidir. Birçok kanser türünde sistemik enflamatuar yanıt göstergesi olan Nötrofil-lenfosit oranı (NLR) ve platelet-lenfosit oranının (PLR) preoperatif evreleme amacıyla kullanılmaktadır. KRK de lenfatik yayılım ve len nodu(LN) pozitifliği de tedavi kararı için önemli bir parametredir. Biz bu çalışmamızda KRK hastalarında preoperatif dönemde yapılan görüntülemelerin ve labarotuvar bulgularının LN metatsatzını öngörmedeki değerlerini saptamayı amaçladık. Materyal ve metod Ocak 2015-Ocak 2021 tarihleri arasında KRK nedeniyle opere edilen hastalar çalışmaya alındı. Hastaların demografik bilgileri, tümörlerine ait bilgileri, preoperatif bilgisayarlı tomografi (BT) ve manyetik rezonans (MR) görüntüleme bilgileri, preoperetif laboratuar bilgileri kayıt altına alındı. Postoperatif patoloji raporundaki LN metastazını önceden tahmin edilmesini belirlemek amacıyla tüm parametreler istatistiksel olarak değerlendirildi. P<0.05 değeri istatistiksel olarak anlamlı kabul edildi. Bulgular: Çalışmaya dahil edilen 410 hastanın 239’u (%58,3) erkek, 171’i (%41,7) kadındı. Çalışamaya dahil edilen hastaların 235’inde (%57,3) postoperatif patoloji raporuna göre LN metastazı saptanmadı (N0). LN metastazı olan hastaların 137’sinde N1, 38’inde N2 düzeyinde LN metastazı vardı. Karsinoembriyojenik antijen (CEA) değeri >5 olan hastalarda ise N0 evresinde olan hastaların yüzdesi %18,7 olarak saptanırken N2 evresinde olan hastaların oranı %44 olarak bulundu (p<0,05). LN metastazı varlığına etkisi olabilecek tümöral faktörlerden LVİ ve Nöral invazyonun LN metastazını anlamlı olarak arttırdığı saptanmıştır (p<0.05). BT’nin Ln metastazını saptamada duyarlılığı %58,19, özgüllüğü %55,49, pozitif doğruluk değeri %47,97, negatif doğruluk değeri %65,30 olarak saptanmıştır. Sonuç: Sonuç olarak KRK de preoepratif dönemde CEA değeri yüksek olan, LVİ olan ve Nİ olan hastalarda Bt ile de desteklenen durumlarda LN metastazı varlığı düşünülmelidir.

Anahtar Kelimeler

• Kolorektal Cerrahi;
• Lenf Nodu Diseksiyonu
• Lenf Nodu Metastazi
• Ameliyat Öncesi Değerlendirme
• Cerrahi Onkoloji

Kaynakça

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