171O - Development of nomogram for predicting lymph node metastases in submucosal colorectal cancer

Date 19 December 2016
Event ESMO Asia 2016 Congress
Session Gastrointestinal tumours
Topics Colon and Rectal Cancer
Rectal Cancer
Pathology/Molecular Biology
Presenter Shiki Fujino
Citation Annals of Oncology (2016) 27 (suppl_9): ix53-ix67. 10.1093/annonc/mdw581
Authors S. Fujino1, N. Miyoshi2, M. Ohue2, M. Yasui2, Y. Fujiwara2, M. Yano2, M. Higashiyama2, M. Sakon2
  • 1Gastroenterological Surgery, Osaka University, 565-0871 - Osaka/JP
  • 2Surgery, Osaka Medical Center for Cancer and Cardiovascular Dideases, 537-8511 - Osaka/JP



In colorectal cancer (CRC), the possibility of lymph node (LN) metastases is important to select the treatment. According to the Japanese Society for Cancer of the Colon and Rectum guidelines for the treatment of colorectal cancer (JSCCR Guidelines), the surgical resection with LN dissection is generally recommended for submucosal (SM) CRC. However, some SM CRC without the risk factors relating to LN metastases are treated only endoscopically. The probability of LN metastasis is about 10% in SM CRC, and we developed a nomogram to predict LN metastases more accurately in each patient.


509 patients with SM CRC were retrospectively investigated from 1984 to 2008. All patients underwent curative surgical resection at the Osaka Medical Center for Cancer and Cardiovascular Diseases. 113 patients with inadequate pathological data were excluded. 293 patients who underwent surgery from 1984 to 2008 were included in the training-set (TS), and a logistic regression model was used to develop the prediction model for LN metastases. 103 patients who underwent surgery from 2009 to 2012 were included in the validation-set (VS), and the developed prediction model was validated.


Univariate analysis of pathological factors showed that tumor invasion depth (0.098), positive lymphatic invasion (P 


We evaluated the risk factors of lymph node metastases in SM CRC, and made a novel nomogram for predicting LN metastases. Our nomogram can help to decide the additional surgical treatment after endoscopic resection for each patient. This prediction model may help clinicians to decide the personalized treatment following endoscopic resection.

Clinical trial indentification

Legal entity responsible for the study

Osaka Medical Center for Cancer and Cardiovascular Diseases Ethics Committee


Osaka Medical Center for Cancer and Cardiovascular Diseases


All authors have declared no conflicts of interest.