Patients with colorectal liver metastases (CRLM) combined with hepatic lymph node (HLN) metastases have a poor prognosis. In this study, we developed and validated a model using clinical and magnetic resonance imaging (MRI) parameters to predict HLN status before surgery. A total of 104 CRLM patients undergoing hepatic lymphonodectomy with pathologically confirmed HLN status after preoperative chemotherapy were enrolled in this study. The patients were further divided into a training group (n = 52) and a validation group (n = 52). The apparent diffusion coefficient (ADC) values, including ADCmean and ADCmin of the largest HLN before and after treatment, were measured. rADC was calculated referring to the target liver metastases, spleen, and psoas major muscle (rADC-LM, rADC-SP, rADC-m). In addition, ADC change rate (Δ% ADC) was quantitatively calculated. A multivariate logistic regression model for predicting HLN status in CRLM patients was constructed using the training group and further tested in the validation group. In the training cohort, post-ADCmean (P = 0.018) and the short diameter of the largest lymph node after treatment (P = 0.001) were independent predictors for metastatic HLN in CRLM patients. The model’s AUC was 0.859 (95% CI, 0.757-0.961) and 0.767 (95% CI 0.634-0.900) in the training and validation cohorts, respectively. Patients with metastatic HLN showed significantly worse overall survival (p = 0.035) and recurrence-free survival (p = 0.015) than patients with negative HLN. The developed model using MRI parameters could accurately predict HLN metastases in CRLM patients and could be used to preoperatively assess the HLN status and facilitate surgical treatment decisions in patients with CRLM.

中文翻译：

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基于磁共振成像预测结直肠癌肝转移手术切除患者术前化疗前后肝淋巴结转移

结直肠肝转移（CRLM）合并肝淋巴结（HLN）转移的患者预后较差。在这项研究中，我们开发并验证了一个使用临床和磁共振成像 (MRI) 参数预测手术前 HLN 状态的模型。共有 104 名 CRLM 患者在术前化疗后接受了肝淋巴结切除术，并经病理证实为 HLN 状态。患者进一步分为训练组 (n = 52) 和验证组 (n = 52)。测量治疗前后最大 HLN 的表观扩散系数 (ADC) 值，包括 ADCmean 和 ADCmin。rADC 是根据目标肝转移、脾脏和腰大肌 (rADC-LM、rADC-SP、rADC-m) 计算的。此外，定量计算 ADC 变化率 (Δ% ADC)。使用训练组构建了用于预测 CRLM 患者 HLN 状态的多变量逻辑回归模型，并在验证组中进一步测试。在训练队列中，ADC 后平均值 (P = 0.018) 和治疗后最大淋巴结的短直径 (P = 0.001) 是 CRLM 患者转移性 HLN 的独立预测因子。该模型在训练和验证队列中的 AUC 分别为 0.859（95% CI，0.757-0.961）和 0.767（95% CI 0.634-0.900）。转移性 HLN 患者的总生存率 (p = 0.035) 和无复发生存率 (p = 0.015) 明显低于 HLN 阴性患者。