Pathologic complete response implies a fewer number of lymph nodes in specimen of rectal cancer patients treated by neoadjuvant therapy and total mesorectal excision

Bustamante-Lopez, Leonardo Alfonso; Nahas, Caio Sérgio Rizkallah; Nahas, Sérgio Carlos; Marques, Carlos Frederico Sparapan; Pinto, Rodrigo Ambar; Cotti, Guilherme Cutait de Castro; Imperiale, Antônio Rocco; Mello, Evandro Sobroza de; Ribeiro, Ulysses; Cecconello, Ivan

doi:10.1016/j.ijsu.2018.07.001

Cited by 13 publications

(6 citation statements)

References 27 publications

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“…At this point, patients who had post-CRT ∆LNN ≥ 70% would be more easier to achieve CR. Bustamante-Lopez et al (31) found only pCR showed a signi cant association with < 12 baseline LN. However, none of the previous studies had indicated correlation between post-CRT ∆LNN or post-CCT ∆LNV and response so far.…”

Section: Discussionmentioning

confidence: 90%

Predicting Response to Total Neoadjuvant Treatment (TNT) in Locally Advanced Rectal Cancer Based on Multiparametric Magnetic Resonance Imaging: A Retrospective Study

Ouyang

Yang

Deng

et al. 2020

Preprint

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Purpose: To investigate the potential value of magnetic resonance imaging (MRI) in predicting response relevance to total neoadjuvant treatment (TNT) in locally advanced rectal cancer.Methods: We analyzed MRI of 71 patients underwent TNT from 2015 to 2017 retrospectively. We categorized the response of TNT as CR (complete response) and non-CR, and high, moderate and low sensitivity. Logistic regression analysis was used to identify the best predictors of response. Diagnostic performance was assessed using receiver - operating characteristic curve analysis.Results: Post–ICT (induction chemotherapy) ∆TL (tumor length), post-CRT (concurrent chemoradiotherapy) ∆LNN (the numbers of lymph node metastases), post–CCT (consolidation chemotherapy) ∆SDWI (maximum cross-sectional area of tumor on diffusion-weighted imaging), post-CCT ADCT (the mean apparent diffusion coefficient values of tumor) and post-CCT ∆LNV (volume of lymph node) were the best CR predictors. Post-CRT EMVI (extramural vascular invasion) and post-CCT ∆ST2 (S on T2-weight) were the best significant factors for high sensitivity. Conclusions: Post-ICT ∆TL and post-CRT EMVI may an early predictor of CR and high sensitivity to TNT, respectively. The grouping scheme of CR and non–CR was more suitable for predicting response by MRI parameters than high, moderate and low sensitivity.Trial registration: retrospectively registered

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Section: Discussionmentioning

confidence: 90%

Predicting Response to Total Neoadjuvant Treatment (TNT) in Locally Advanced Rectal Cancer Based on Multiparametric Magnetic Resonance Imaging: A Retrospective Study

Ouyang

Yang

Deng

et al. 2020

Preprint

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“…Esophageal cancer is a growing health issue expected to increase in incidence over the next years due to the upsurge of gastroesophageal reflux disease and obesity 4 , 15 . It is still a challenging disease with a poor prognosis despite the advances in chemoradiotherapy 2 and all the progress made in the last years in minimally invasive surgery and postoperative management 19 .…”

Section: Introductionmentioning

confidence: 99%

Transhiatal Esophagectomy Is Not Associated With Poor Quality Lymphadenectomy

Takeda

Tustumi

Nigro

et al. 2019

ABCD, arq. bras. cir. dig.

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Background:Esophageal cancer neoadjuvant therapy followed by surgery increases the likelihood of treatment success. Aim:To evaluate variables that can influence the number of retrieved lymph nodes, the number of retrieved metastatic lymph nodes and lymphnodal recurrence in esophagectomy after neoadjuvant chemoradiotherapy. Methods:Patients of a single institute were evaluated after completion of trimodal therapy. Univariate and multivariate analyses were performed to evaluate variables that can influence in the number of retrieved lymph nodes and retrieved metastatic lymph nodes. Results:One hundred and forty-nine patients were included. Thoracoscopy access was considered an independent factor for the number of lymph nodes retrieved, but was neither related to the number of positive lymph nodes retrieved nor to lymphnodal recurrence. Pathological complete response on the primary tumor and male were independent variables associated with the number of positive lymph node retrieved. Pathological complete response on the primary tumor site did not statistically influence the likelihood of a lower number of lymph nodes retrieved. Conclusion:Patients submitted to esophagectomy after neoadjuvant chemoradiotherapy, thoracoscopic access is more accurate for pathological staging, even in a complete pathological response. With a proper patient selection, transhiatal surgery may preserve the quality of lymphadenectomy of the positive lymph nodes.

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“…In accordance with our findings, Awwad et al 23 it is unclear whether this is of clinical or prognostic importance. 9,24,25 Remarkably, the survival curves of patients with LNC < 12 were even above those with higher LNC (Figure 2). The number of benign lymph nodes will be sparser in surgical specimens through lymphoid tissue involution after neo-adjuvant treatment.…”

Section: Discussionmentioning

confidence: 89%

“…In accordance with our findings, Awwad et al 23 reported no statistically significant effect of LNC on OS in rectal cancer patients after CRT in their systematic review. LNC after CRT not meeting the minimum requirement of 12 lymph nodes is often reported, however, it is unclear whether this is of clinical or prognostic importance 9,24,25 . Remarkably, the survival curves of patients with LNC < 12 were even above those with higher LNC (Figure 2).…”

Section: Discussionmentioning

confidence: 98%

Prognostic importance of lymph node count and ratio in rectal cancer after neoadjuvant chemoradiotherapy: Results from a cross‐sectional study

Detering

Meyer

Borstlap

et al. 2021

Journal of Surgical Oncology

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Background: The aim of this study was to determine the prognostic value of lymph node count (LNC) and lymph node ratio (LNR) in rectal cancer after neoadjuvant chemoradiotherapy (CRT). Methods: Patients who underwent neoadjuvant CRT and total mesorectal excision (TME) for Stage I-III rectal cancer were selected from a cross-sectional study including 71 Dutch centres. Primary outcome parameters were disease-free survival (DFS) and overall survival (OS). Prognostic significance of LNC and LNR (cut-off values 0.15, 0.20, 0.30) was tested for different (sub)groups.Results: From 2095 registered patients, 458 were included, of which 240 patients with LNC < 12 and 218 patients with LNC ≥ 12. LNC was not significantly associated with DFS (p = 0.35) and OS (p = 0.59). In univariable analysis, LNR was significantly associated with DFS and OS in the whole cohort and LNC subgroups, but not in multivariable analysis.Conclusions: LNC was not associated with long-term oncological outcome in rectal cancer patients treated with CRT, nor was LNR when corrected for N-stage.However, LNR might be used to identify subgroups of node-positive patients with a favourable outcome.

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Pathologic complete response implies a fewer number of lymph nodes in specimen of rectal cancer patients treated by neoadjuvant therapy and total mesorectal excision

Abstract: Complete pathologic response is associated with <12 L N harvested. Thus, the number of lymph nodes should not be used as a surrogate for oncologic adequacy of resection in patients with pathologic complete response.

Cited by 13 publications

References 27 publications

Predicting Response to Total Neoadjuvant Treatment (TNT) in Locally Advanced Rectal Cancer Based on Multiparametric Magnetic Resonance Imaging: A Retrospective Study

Predicting Response to Total Neoadjuvant Treatment (TNT) in Locally Advanced Rectal Cancer Based on Multiparametric Magnetic Resonance Imaging: A Retrospective Study

Transhiatal Esophagectomy Is Not Associated With Poor Quality Lymphadenectomy

Prognostic importance of lymph node count and ratio in rectal cancer after neoadjuvant chemoradiotherapy: Results from a cross‐sectional study

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Pathologic complete response implies a fewer number of lymph nodes in specimen of rectal cancer patients treated by neoadjuvant therapy and total mesorectal excision

Abstract: Complete pathologic response is associated with <12 L N harvested. Thus, the number of lymph nodes should not be used as a surrogate for oncologic adequacy of resection in patients with pathologic complete response.

Cited by 13 publications

References 27 publications

Predicting Response to Total Neoadjuvant Treatment (TNT) in Locally Advanced Rectal Cancer Based on Multiparametric Magnetic Resonance Imaging: A Retrospective Study

Predicting Response to Total Neoadjuvant Treatment (TNT) in Locally Advanced Rectal Cancer Based on Multiparametric Magnetic Resonance Imaging: A Retrospective Study

Transhiatal Esophagectomy Is Not Associated With Poor Quality Lymphadenectomy

Prognostic importance of lymph node count and ratio in rectal cancer after neoadjuvant chemoradiotherapy: Results from a cross‐sectional study

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Abstract: Complete pathologic response is associated with <12 L N harvested. Thus, the number of lymph nodes should not be used as a surrogate for oncologic adequacy of resection in patients with pathologic complete response.