Evaluation of the utility of a nomogram for predicting lymph node metastasis in T1 colorectal cancer in shared decision-making in clinical practice: a survey-based study

Abstract

Purpose In 2019, we reported a novel nomogram to predict lymph node metastasis (LNM) in T1 colorectal cancer. Herein, we conducted a survey-based study to evaluate the clinical utility of this nomogram in determining the need for additional surgery after endoscopic resection for high-risk T1 colorectal cancer. Methods A survey was conducted among 77 members of the Korean Society of Coloproctology and 25 members of the Korean Society of Gastrointestinal Endoscopy. The survey assessed decision-making regarding additional surgery after endoscopic resection for high-risk T1 colorectal cancer according to various predicted LNM rates (3%, 10%, and 27%) and tumor locations (anal verge [AV] 2, 7, and 25 cm). Additionally, participants provided feedback regarding the reliability, usefulness, and potential adoptability of the prediction model in patient counseling. Results Of the 2,314 surveys distributed, 102 responses were analyzed. A trend was observed in which tumors located closer to the anus and associated with a lower predicted risk of LNM were less likely to lead respondents to opt for surgery (e.g., AV 2 cm and 3% of predicted LNM risk, 21.6% opt for surgery vs. AV 25 cm and 27% of predicted LNM risk, 98.0% opt for surgery). Additionally, 94.1% of the respondents reported that the prediction model would be helpful in clinical decision-making and patient counseling. Conclusion Our findings suggest that the nomogram is an effective and reliable tool for guiding treatment strategies and enhancing consultations in patients with T1 colorectal cancer.

Keywords

• colorectal neoplasms
• lymph nodes
• neoplasm metastasis
• nomograms
• surveys and questionnaires