• Andrew D Newton, Jiaqi Li, Arjun N Jeganathan, Najjia N Mahmoud, Andrew J Epstein, and E Carter Paulson.
• 1 Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 2 Department of Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 3 Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 4 Department of Surgery, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.
• Dis. Colon Rectum. 2016 Aug 1; 59 (8): 710-7.

BackgroundPatients with locally advanced rectal cancer typically receive neoadjuvant chemoradiation followed by total mesorectal excision. Other treatment approaches, including transanal techniques and close surveillance, are becoming increasingly common following positive responses to chemoradiation. Lack of pathologic lymph node staging is one major disadvantage of these novel strategies.ObjectiveThe purposes of this study were to determine clinicopathologic factors associated with positive lymph nodes following neoadjuvant chemoradiation for rectal cancer and to create a nomogram using these factors to predict rates of lymph node positivity.DesignThis is a retrospective cohort analysis.SettingsThis study used the National Cancer Database.PatientsPatients aged 18 to 90 with clinical stage T3/T4, N0, M0 or Tany, N1-2, M0 adenocarcinoma of the rectum who underwent neoadjuvant chemoradiation before total mesorectal excision from 2010 to 2012 were identified.Main Outcome MeasuresThe primary outcome measure was lymph node positivity after neoadjuvant chemoradiation for locally advanced rectal cancer. Bivariate and multivariate analyses were used to determine the associations of clinicopathologic variables with lymph node positivity.ResultsEight thousand nine hundred eighty-four patients were included. Young age, lower Charlson score, mucinous histology, poorly differentiated and undifferentiated tumors, the presence of lymphovascular invasion, elevated CEA level, and clinical lymph node positivity were significantly predictive of pathologic lymph node positivity following neoadjuvant chemoradiation. The predictive accuracy of the nomogram is 70.9%, with a c index of 0.71. There was minimal deviation between the predicted and observed outcomes.LimitationsThis study is retrospective, and it cannot be determined when in the course of treatment the data were collected.ConclusionsWe created a nomogram to predict lymph node positivity following neoadjuvant chemoradiation for locally advanced rectal cancer that can serve as a valuable complement to imaging to aid clinicians and patients in determining the best treatment strategy.

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