What question did this study set out to answer?

This study aims to develop and validate a nomogram for predicting the feasibility of sphincter-preserving surgery in mid-low rectal cancer.

May 17, 2026Chinese Journal of Cancer Research0 citationsOpen Access

Development and validation of a multiparametric magnetic resonance imaging-based nomogram for predicting feasibility of sphincter-preserving surgery in mid-low rectal cancer

JWJuan Wang CTChang Tianjing TLTang Lili

Key Points

This study aims to develop and validate a nomogram for predicting the feasibility of sphincter-preserving surgery in mid-low rectal cancer.
Retrospective analysis of 335 patients with rectal adenocarcinoma (DTAV 3−8 cm), divided into training (n=263) and validation (n=72) cohorts.
Predictors identified through multivariate logistic regression analysis and model discrimination evaluated using AUC and calibration tests.
Subgroup analyses conducted within DTAV strata.
Four independent predictors identified: larger DTAV (OR=5.00, P<0.001), larger pubococcygeal overlap distance (OR=1.08, P=0.001), transverse diameter of mesorectal fat (OR=1.07, P=0.017), and subcutaneous adipose tissue thickness (OR=0.94, P=0.016).
The SPARC nomogram achieved an AUC of 0.928 in the training cohort, better than DTAV alone (AUC=0.884, P=0.031) and maintained an AUC of 0.916 in external validation.
Decision curve analysis showed significant clinical benefit across various threshold probabilities.

Abstract

ObjectiveAlthough distance from the inferior tumor edge to the anal verge (DTAV) is a key predictor for sphincter-preserving surgery (SPS) in mid-low rectal cancer, its utility is limited in the “decision-gray zone” (DTAV, 3−8 cm). Therefore, this study aimed to develop and validate a multiparametric magnetic resonance imaging-based nomogram for individualized preoperative prediction of SPS feasibility. MethodsThis dual-center retrospective study included 335 patients with rectal adenocarcinoma (DTAV 3−8 cm). Patients were divided into training (n=263) and external validation (n=72) cohorts, and predictors were identified using multivariate logistic regression analysis. Model discrimination was assessed using area under the receiver operating curve (AUC) and calibration via the Hosmer-Lemeshow test. Subgroup analyses were performed across DTAV strata. ResultsFour independent predictors were identified: larger DTAV [odds ratio (OR) =5.00, PConclusionsThe SPARC nomogram reliably predicted SPS feasibility by integrating tumor location with pelvic anatomy and fat distribution. This provides valuable and evidence-based preoperative guidance, especially within the DTAV 3−8 cm gray zone.

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