MRI‐based parameters and clinical risk factors to predict lymph node metastasis in patients with ypT0 rectal cancer after neoadjuvant chemoradiotherapy

Abstract Backgrounds The aim of this study was to assess the significant risk factors that predict lymph node metastasis in ypT0 patients with locally advanced rectal cancer following chemoradiotherapy (CRT). Additionally, the study aimed to identify high‐risk groups who would not be suitable candidates for a rectal‐preserving strategy, despite achieving a complete tumour response. Methods Between 2013 and 2021, 226 ypT0 patients with stages II/III rectal cancer underwent CRT and radical surgery were enrolled. Two groups of patients were evaluated: those with lymph nodes metastasis and those without. The selection of variables for multivariable logistic regression was conducted through bivariate logistic regression analysis. Furthermore, the determination of optimal cutoff values for risk factors was achieved using ROC curve analysis. Results Nearly 8% (18/226) of patients with ypT0 had positive lymph nodes (LN) on final pathology. Four variables resulted as being independent factors of LN metastasis: pre‐CRT tumour movability (OR = 8.618, P = 0.003), pre‐CRT maximal LN size (OR = 28.474, P = 0.004), post‐CRT tumour vertical length (OR = 1.492, P = 0.050), post‐CRT anaemia (OR = 10.288, P = 0.001). The optimal cutoff point of pre‐CRT maximal LN size and post‐CRT tumour vertical length was 7.50 mm and 3.05 cm, respectively. Conclusion The prevalence of lymph node metastasis remains at 8% among patients who achieve pathological complete regression of the primary tumour. In instances where patients are considered appropriate candidates for a rectal‐preserving strategy after clinical complete remission, careful consideration should be given to the selection of this strategy if specific risk factors are present. These risk factors encompass a maximal LN size surpassing 7.50 mm prior to CRT, a fixed tumour prior to CRT, a tumour vertical length exceeding 3.05 cm after CRT, and the existence of anaemia subsequent to CRT.