A Clinicopathological Feature-Based Nomogram for Predicting the Likelihood of D3 Lymph Node Metastasis in Right-Sided Colon Cancer Patients

BACKGROUND: Despite advancements in treating right-sided colon cancer patients, the ideal scope of lymphadenectomy remains controversial. OBJECTIVE: Our objective was to investigate the likelihood of D3 lymph node metastasis in right-sided colon cancer patients and develop a clinicopathological feature-based nomogram for D3 lymphadenectomy. DESIGN: We retrospectively analyzed 286 right-sided colon cancer patients who underwent D3 lymphadenectomy. The patients were divided into 2 groups based on whether D3 lymph node metastasis was positive. Then, univariable and multivariable logistic regression analyses were performed to obtain independent risk factors for predicting D3 lymph node metastasis. Moreover, we performed receiver operating characteristic curve analyses to evaluate the predictive power of the model. SETTING: This study was conducted at Nanfang Hospital of Southern Medical University in China. PATIENTS: A total of 286 consecutive patients who underwent right hemicolectomy and D3 lymphadenectomy as a primary treatment for right-sided colon cancer between January 2016 and December 2019 were enrolled in this study. MAIN OUTCOME MEASURES: The primary measures were independent risk factors for predicting D3 lymph node metastasis in right-sided colon cancer. RESULTS: The D3 lymph node metastasis rate in right-sided colon cancer patients was 16.1% (46/286). D3 lymphadenectasis on CT, lymphatic invasion, and T4 tumors were filtered out as independent risk factors for D3 lymph node metastasis according to the multivariable logistic regression analysis. We established a nomogram that predicted D3 lymph node metastasis of right-sided colon cancer on the combination of the 3 factors with an area under the curve of 0.717 (95% CI, 0.629-0.806). LIMITATIONS: This was a retrospective study from a single center. CONCLUSIONS: We developed a valuable clinicopathological feature-based nomogram to predict the incidence of D3 lymph node metastasis in right-sided colon cancer patients. Patients with D3 lymphadenectasis on CT, preoperative T4 tumors, and lymphatic invasion should undergo D3 lymphadenectomy. See Video Abstract at http://links.lww.com/DCR/B852.