# Prediction of lymph node metastasis in T1 colorectal cancer based on combination of body composition and vascular invasion

## TL;DR

This study shows that combining body composition measurements and vascular invasion can better predict lymph node metastasis in early-stage colorectal cancer patients.

## Contribution

The novel contribution is a predictive model combining body composition and vascular invasion for lymph node metastasis in T1 colorectal cancer.

## Key findings

- The SMA/VFA ratio and vascular invasion were independent risk factors for lymph node metastasis.
- Combining SMA/VFA and vascular invasion improved predictive accuracy with an AUROC of 0.789.
- The model outperformed single indicators like vascular invasion alone.

## Abstract

Lymph node metastasis (LNM) in colorectal cancer (CRC) patients is not only associated with the tumor’s local pathological characteristics but also with systemic factors. This study aims to assess the feasibility of using body composition and pathological features to predict LNM in early stage colorectal cancer (eCRC) patients.

A total of 192 patients with T1 CRC who underwent CT scans and surgical resection were retrospectively included in the study. The cross-sectional areas of skeletal muscle, subcutaneous fat, and visceral fat at the L3 vertebral body level in CT scans were measured using Image J software. Logistic regression analysis were conducted to identify the risk factors for LNM. The predictive accuracy and discriminative ability of the indicators were evaluated using receiver operating characteristic (ROC) curves. Delong test was applied to compare area under different ROC curves.

LNM was observed in 32 out of 192 (16.7%) patients with eCRC. Multivariate analysis revealed that the ratio of skeletal muscle area to visceral fat area (SMA/VFA) (OR = 0.021, p = 0.007) and pathological indicators of vascular invasion (OR = 4.074, p = 0.020) were independent risk factors for LNM in eCRC patients. The AUROC for SMA/VFA was determined to be 0.740 (p < 0.001), while for vascular invasion, it was 0.641 (p = 0.012). Integrating both factors into a proposed predictive model resulted in an AUROC of 0.789 (p < 0.001), indicating a substantial improvement in predictive performance compared to relying on a single pathological indicator.

The combination of the SMA/VFA ratio and vascular invasion provides better prediction of LNM in eCRC.

The online version contains supplementary material available at 10.1007/s00384-024-04653-4.