Number of lymph nodes assessed has no prognostic impact in node-negative rectal cancers after neoadjuvant therapy. Results of the “Italian Society of Surgical Oncology (S.I.C.O.) Colorectal Cancer Network” (SICO-CCN) multicentre collaborative study

Degiuli, Maurizio; Arolfo, Simone; Evangelista, Andrea; Lorenzon, Laura; Reddavid, Rossella; Staudacher, C.; Nardi, Paola De; Rosati, Riccardo; Elmore, Ugo; Coco, Claudio; Rizzo, Gianluca; Belluco, Claudio; Forlin, Marco; Milone, Marco; Palma, Giovanni Domenico De; Rega, Daniela; Delrio, Paolo; Guerrieri, Mario; Ortenzi, Monica; Muratore, Andrea; Marsanic, Patrizia; Restivo, Angelo; Deidda, Simona; Zuin, M.; Pucciarelli, Salvatore; Luca, Raffaele De; Persiani, Roberto; Biondi, Alberto; Roviello, Franco; Marrelli, Daniele; Sgroi, Giovanni; Turati, Luca; Morino, Mario

doi:10.1016/j.ejso.2018.04.007

Cited by 18 publications

(16 citation statements)

References 31 publications

(34 reference statements)

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“…Given the decreased LNY after neo‐CRT, Degiuli et al focused on clinical significance of the complete absence of LNs harvested (ypNnull). Interestingly, ypNnull patients exhibited the worst prognosis comparing to both ypN0 and ypN + patients, which was contrary to several other articles …”

Section: Discussionmentioning

confidence: 99%

Increased lymph node yield indicates improved survival in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy

et al. 2019

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Purpose It is recommended for colorectal cancer to harvest at least 12 lymph nodes (LNs) during surgery to avoid understaging of the disease. However, it is still controversial whether it is necessary to harvest from locally advanced rectal cancer (LARC) patients who underwent neoadjuvant chemoradiotherapy (neo‐CRT). The impact of lymph node yield (LNY) on prognosis in LARC patients was analyzed. Materials/Methods In total, 495 LARC patients who underwent neo‐CRT in 2006‐2015 were analyzed. After examining clinicopathological distribution differences between the LNY subgroups (with the threshold of 12), univariate and multivariate Cox survival analyses were performed. Survival plots were obtained from Kaplan‐Meier analyses. Similar subgroup analyses were performed according to the tumor regression grade (TRG) and metastatic status of post‐operational LNs. Results Of the 495 patients, 287 (57.98%) had an LNY of less than 12. Nearly no significant clinicopathological difference was found between the LNY subgroups, including the TRG scores. Multivariate survival analysis demonstrated that at least 12 LNs examined was an independent prognostic feature of good overall survival (OS), disease‐free survival (DFS), and distant metastasis free survival (DMFS), but not local recurrence free survival (LRFS). However, in the subgroup analyses, no association was found between LNY and prognosis in patients with good TRG scores (0‐1) or negative LNs. Conclusions For LARC patients treated with neo‐CRT, an LNY of at least 12 indicated an improved survival. Decreased LNY was not related to better tumor regression. It suggests that a sufficiently high LNY is still required, especially in those with a potentially poor tumor response.

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Section: Discussionmentioning

confidence: 99%

Increased lymph node yield indicates improved survival in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy

et al. 2019

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“…Fourth, there is a possibility that individual differences in the number of LNs are related to prognosis. Fifth, large amounts of perigastric lymphoid tissue may be linked to increased barriers to defense against metastasis and robust tumor immunity [15,16]. We believe that our findings of a relative and significant increase in the prevalence of nodal occurrence in the RLN < 40 group are not surprising.…”

Section: Discussionmentioning

confidence: 67%

“…The number of RNLs serves as a prognostic factor for gastric cancer as well as for postoperative survival from certain cancers [9,15,19,20]. For example, for colorectal cancer, > 12 RLNs are recommended; and in the absence of ≥ 12 evaluated nodes, patients should be treated with adjuvant chemotherapy [16]. Moreover, an increase in the number of RLNs is associated with longer survival of patients with node-positive cervical cancer [15].…”

Section: Discussionmentioning

confidence: 99%

“…Numerous studies report that the presence, position, and number of positive LNs serve as significant prognostic factors [13,14]. However, the number of LNs linked to prognosis is known only for certain gastrointestinal malignancies [9,15,16]. Moreover, it is unclear whether variables such as surgical procedure, range of lymphadenectomy, and disease stage influence the ability of the number of RLNs to predict prognosis of patients with resectable but advanced gastric cancer.…”

Section: Introductionmentioning

confidence: 99%

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Number of retrieved lymph nodes is an independent prognostic factor after total gastrectomy for patients with stage III gastric cancer: propensity score matching analysis of a multi-institution dataset

et al. 2018

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Background The prognostic significance of the number of retrieved lymph nodes (RLNs) in gastric cancer remains controversial. Therefore, we designed a multicenter collaborative database to investigate the correlation between the number of RLNs and prognosis of patients with advanced gastric cancer after curative resection. Methods We retrospectively analyzed 1103 patients who underwent gastrectomy for stage II/III gastric cancer between 2010 and 2014. Lymph nodes, which were retrieved by surgeons from surgically resected specimens, were validated by pathologists. A target population and the optimal cutoff were determined using receiver operating characteristic (ROC) curve analysis. After propensity score matching of eight variables, including splenectomy and adjuvant chemotherapy, the prognostic significance of RLNs was evaluated. Results According to ROC curve analysis, the optimum cutoff score for predicting postoperative survival was 40. After matching, the backgrounds of patients in the RLN < 40 and RLN ≥ 40 groups (n = 87 each) became well-balanced. The RLN < 40 group experienced significantly shorter relapse-free and overall survival. The prevalence of peritoneal recurrence was significantly increased in the RLN < 40 group. RLN < 40 was an independent prognostic factor in multivariable analysis, although pathological N status was not. A forest plot revealed that the RLN < 40 group was at greater risk of recurrence in most subgroups. Conclusions RLN < 40 was associated with an adverse prognosis of patients with stage III gastric cancer who underwent total gastrectomy.

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“…Although the authors included a large number of rectal cancer patients, no subgroup analysis was performed. Studies have shown that a lower LN retrieval in patients with good tumour regression grade or node‐negative disease following neoadjuvant chemoradiotherapy is associated with improved, or does not affect, survival. In these groups of patients, low LN retrieval is an indicator for a good tissue response to neoadjuvant chemoradiotherapy rather than inadequate surgery.…”

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confidence: 99%

Correspondence

Hamid¹

2019

British Journal of Surgery

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We read the recent article by Duchalais and colleagues 1 , with great interest. There are several aspects of the article with which one might take issue.First, the multivariate analysis yielded that a smaller number of lymph nodes (LNs) was independently associated with shorter overall survival. Although the authors included a large number of rectal cancer patients, no subgroup analysis was performed. Studies have shown that a lower LN retrieval in patients with

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Number of lymph nodes assessed has no prognostic impact in node-negative rectal cancers after neoadjuvant therapy. Results of the “Italian Society of Surgical Oncology (S.I.C.O.) Colorectal Cancer Network” (SICO-CCN) multicentre collaborative study

Cited by 18 publications

References 31 publications

Increased lymph node yield indicates improved survival in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy

Increased lymph node yield indicates improved survival in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy

Number of retrieved lymph nodes is an independent prognostic factor after total gastrectomy for patients with stage III gastric cancer: propensity score matching analysis of a multi-institution dataset

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