Analysis Of Risk Factors Associated With Lymph Node Metastasis Of Colon Cancer And The Establishment Of Prediction Mode

Objective:To investigate the predictive value of preoperative serum tumor markers,serum enzymatic tests and clinicopathological features on lymph node metastasis in colorectal cancer.Methods:366 patients with colon cancer who underwent the surgical treatment in the department of gastrointestinal colorectal and anal surgery of China-Japan Union Hospital of Jilin University from January 2017 to December 2019 were selected as the research objects.The patients were divided into two groups according to whether their lymph nodes were metastatic or not on postoperative pathological findings.General information,clinicopathological characteristics and preoperative carcinoembryonic antigen(CEA),carbohydrate antigen 199(CA199),lactate dehydrogenase(LDH)and glutamate dehydrogenase(GDH)test results were collected from both groups and a database was established.Statistical analysis was first performed using SPSS 23.0software.The general characteristics and various clinicopathological features of the two groups were analysed using the chi-square test for statistical differences,and the MannWhitney U test was used to compare the serum levels of CEA,CA199,LDH and GDH in the two groups.The indicators with statistical differences were subjected to binary logistic multi-factor regression analysis and prediction models were built.Subject operating characteristic(ROC)curves were constructed to evaluate the efficacy of various indicators tested alone and the predictive models.Results:1.There were significant differences in tumor invasion depth,differentiation degree,vascular invasion,nerve invasion and preoperative serum CEA,CA199,GDH levels between patients with and without lymph node metastasis.2.Tumor invasion depth(OR=2.768),vascular invasion(OR=9.142),serum CEA level(OR=1.018)and serum GDH level(OR=1.116)were independent risk factors for lymph node metastasis in colon cancer.The quadruple prediction model for lymph node metastasis is: Logit(P1)=-2.996+1.018*Tumor invasion depth+2.213*Vascular invasion +0.018*CEA+0.109*GDH.The triple prediction model for lymph node metastasis is: Logit(P2)=-2.996+1.018* Tumor invasion depth +0.018*CEA+0.109*GDH.3.The sensitivity of quadruple prediction model,triple prediction model,GDH and CEA in predicting lymph node metastasis were 73.7%,71.2%,64.7% and 28.8%respectively,and the specificity were 81%,68.1%,70.5% and 89.5% respectively.The AUC of quadruple prediction model was the highest(0.827),followed by triple prediction model(0.715),single GDH detection(0.655),single CEA detection(0.613).Conclusion:1.Tumor invasion depth,vascular invasion,preoperative serum CEA level and serum GDH level were independent risk factors for lymph node metastasis of colon cancer.2.Combined with CEA,GDH,tumor invasion depth and vascular invasion,the quadruple prediction model has the highest diagnostic value for lymph node metastasis of colon cancer.However,due to the low accuracy of preoperative judgment of vascular invasion,the quadruple prediction model can only be used for further verification of lymph node metastasis after operation to reduce the missed detection rate and guide postoperative chemotherapy.3.Combined with CEA,GDH and tumor invasion depth,the triple prediction model is superior to the single laboratory test in predicting lymph node metastasis of colon cancer,but because of its low specificity,it can only be used as a reference for preoperative judgment of lymph node metastasis of colon cancer.