Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jul 15, 2024; 16(7): 3299-3307
Published online Jul 15, 2024. doi: 10.4251/wjgo.v16.i7.3299
Clinical and pathological features of advanced rectal cancer with submesenteric root lymph node metastasis: Meta-analysis
Qi Wang, Fu-Xiang Zhu, Min Shi
Qi Wang, Department of Colorectal Surgery, Shaoxing People’s Hospital, Shaoxing 312000, Zhejiang Province, China
Fu-Xiang Zhu, Department of Anorectal Surgery, People’s Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
Min Shi, Department of Immunization Program, Shaoxing Center for Disease Control and Prevention, Shaoxing 312000, Zhejiang Province, China
Author contributions: Wang Q wrote the manuscript; Zhu FX collected the data; Shi M guided the study; and all authors reviewed, edited, and approved the final manuscript and revised it critically for important intellectual content, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Min Shi, MM, Doctor, Department of Immunization Program, Shaoxing Center for Disease Control and Prevention, No. 276 Shiji East Street, Shaoxing 312000, Zhejiang Province, China. min122shi321@126.com
Received: March 25, 2024
Revised: April 23, 2024
Accepted: May 8, 2024
Published online: July 15, 2024
Processing time: 109 Days and 1.9 Hours
Abstract
BACKGROUND

Advanced rectal cancer with submesenteric lymph node metastasis is a common complication of advanced rectal cancer, which has an important impact on the treatment and prognosis of patients.

AIM

To investigate the clinical and pathological characteristics of inferior mesenteric artery (IMA) root lymph node metastases in patients with rectal cancer. The findings of this study provided us with fresh medical information that assisted us in determining the appropriate treatment for these patients.

METHODS

Our study searched PubMed, Google Scholar, and other databases and searched the relevant studies and reports on the risk factors of IMA root lymph node metastasis of rectal cancer published in the self-built database until December 31, 2023. After data extraction, the Newcastle-Ottawa scale was used to evaluate the quality of the included literature, and RevMan5.3 software was used for meta-analysis and heterogeneity testing. The fixed effect modules without heterogeneity were selected to combine the effect size, and the random effect modules with heterogeneity were selected to combine the effect size. The cause of heterogeneity was found through sensitivity analysis, and the data of various risk factors were combined to obtain the final effect size, odds ratio (OR) value, and 95% confidence interval (CI). Publication bias was tested by drawing funnel plots.

RESULTS

A total of seven literature were included in this study. By combining the OR value of logistic multivariate regression and the 95%CI of various risk factors, we concluded that the risk factors for lymph node metastasis in the IMA region of rectal cancer were as follows: Preoperative carcinoembryonic antigen (CEA) > 5 ng/mL (OR = 0.32, 95%CI: 0.18-0.55, P < 0.05), tumor located above peritoneal reflexive (OR = 3.10, 95%CI: 1.78-5.42, P < 0.05), tumor size ≥ 5 cm (OR = 0.36, 95%CI: 0.22-0.57, P < 0.05), pathological type (mucinous adenocarcinoma/sig-ring cell carcinoma) (OR = 0.23, 95%CI: 0.13-0.41, P < 0.05), degree of tumor differentiation (low differentiation) (OR = 0.17, 95%CI: 0.10-0.31, P < 0.05), tumor stage (T3-4 stage) (OR = 0.11, 95%CI: 0.04-0.26, P < 0.05), gender and age were not risk factors for IMA root lymph node metastasis in rectal cancer (P > 0.05).

CONCLUSION

Preoperative CEA level, tumor location, tumor size, tumor pathologic type, tumor differentiation, and T stage were correlated with IMA root lymph node metastasis.

Keywords: Rectal cancer; Inferior mesenteric artery root lymph node metastasis; Risk factors; Survival prognosis; Meta-analysis

Core Tip: This study investigated the clinical and pathological features of advanced rectal cancer with submesenteric lymph node metastasis by meta-analysis. We will collect relevant literature, systematically integrate existing research results, and analyze clinical manifestations, pathological features, and factors related to the metastasis of patients. This study has important implications for understanding the pathogenesis, diagnostic markers, and treatment strategies of submesenteric lymph node metastasis in advanced rectal cancer.