Prognostic significance of tumor regression in lymph nodes after neoadjuvant therapy for rectal carcinoma

Fernández-Aceñero, María Jesús; Granja, Mónica; Sastre, Javier; García-Paredes, Beatriz; Muñoz, Lourdes Estrada

doi:10.1007/s00428-015-1901-x

Cited by 16 publications

(11 citation statements)

References 19 publications

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“…Moreover, in line with our observations, intra-observer agreement for the histopathological determination of regressive changes was very good [15]. Other entities in which the prognostic relevance of regression in LN metastases had a prognostic impact were breast [27] and rectal cancer [28].…”

Section: Discussionsupporting

confidence: 87%

Significance of tumour regression in lymph node metastases of gastric and gastro‐oesophageal junction adenocarcinomas

Reim

Novotny

Frieß

et al. 2020

The Journal of Pathology CR

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The presence of lymph node (LN) metastases is one of the most important negative prognostic factors in upper gastrointestinal carcinomas. Tumour regression similar to that in primary tumours can be observed in LN metastases after neoadjuvant therapy. We evaluated the prognostic impact of histological regression in LNs in 480 adenocarcinomas of the stomach and gastro-oesophageal junction after neoadjuvant chemotherapy. Regressive changes in LNs (nodular and/or hyaline fibrosis, sheets of foamy histiocytes or acellular mucin) were assessed by histology. In total, regressive changes were observed in 128 of 480 patients. LNs were categorised according to the absence or presence of both residual tumour and regressive changes (LN−/+ and Reg−/+). 139 cases were LN−/Reg−, 28 cases without viable LN metastases revealed regressive changes (LN−/Reg+), 100 of 313 cases with LN metastases showed regressive changes (LN+/Reg+), and 213 of 313 metastatic LN had no signs of regression (LN+/Reg−). Overall, LN/Reg categorisation correlated with overall survival with the best prognosis for LN−/Reg− and the worst prognosis for LN+/Reg− (p < 0.001). LN−/Reg+ cases had a nearly significant better outcome than LN+/Reg+ (p = 0.054) and the latter had a significantly better prognosis than LN+/Reg− (p = 0.01). The LN/Reg categorisation was also an independent prognostic factor in multivariate analysis (HR = 1.23; 95% CI 1.1-1.38; p < 0.001). We conclude that the presence of regressive changes after neoadjuvant treatment in LNs and LN metastases of gastric and gastrooesophageal junction cancers is a relevant prognostic factor.

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Section: Discussionsupporting

confidence: 87%

Significance of tumour regression in lymph node metastases of gastric and gastro‐oesophageal junction adenocarcinomas

Reim

Novotny

Frieß

et al. 2020

The Journal of Pathology CR

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“…They then indicated that the regression change grading in LNs had an important role in survival analysis[8]. In the study of rectal carcinoma, there were 80% patients that had N0 disease[7], while there were 57.5% that had N0 disease in the study of esophageal carcinoma[8]. However, in our study, only 28% patients had no LN metastasis.…”

Section: Discussionmentioning

confidence: 59%

“…Newman et al[6] detected that after induction of chemotherapy for breast cancer, patients with negative axillary LNs but without regression change had the best outcome, those with positive axillary LNs but without regression change had the worst outcome, and those with pathological response of metastasis tumor in LNs had an intermediate outcome[6]. Fernández-Aceñero et al[7] found that ypN0 rectal carcinoma cases with regression change in LNs after neoadjuvant therapy showed a significantly worse prognosis when compared to the ypN0 cases without regression change in LNs. Bollschweiler et al[8] stratified esophageal carcinoma regression change in LNs after neoadjuvant therapy into three grades: low risk (no LN metastasis and fewer than 3 LNs with central fibrosis), medium risk (no LN metastasis and central fibrosis in 3 or more LNs, or LN metastasis with a LN ratio of less than 0.05) and high risk (all other cases).…”

Section: Discussionmentioning

confidence: 99%

Unnecessity of lymph node regression evaluation for predicting gastric adenocarcinoma outcome after neoadjuvant chemotherapy

Zhu

Sun

Xue

et al. 2019

WJGO

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BACKGROUND Neoadjuvant chemotherapy has been applied worldwide to improve the survival of patients with gastric adenocarcinoma (GAC). The evaluation of histological regression in primary tumors is valuable for predicting prognosis. However, the prognostic effect of regression change in lymph nodes (LNs) remains unclear. AIM To confirm whether the evaluation of regression change in LNs could predict the prognosis of GAC patients who received neoadjuvant chemotherapy followed by surgery. METHODS In this study, we evaluated the histological regression of resected LNs from 192 GAC patients (including those with esophagogastric junction adenocarcinoma) treated with neoadjuvant chemotherapy. We classified regression change and residual tumor in LNs into four groups: (A) true negative LNs with no evidence of a preoperative therapy effect, (B) no residual metastasis but the presence of regression change in LNs, (C) residual metastasis with regression change in LNs, and (D) metastasis with minimal or no regression change in LNs. Correlations between regression change and residual tumor groups in LNs and regression change in the primary tumor, as well as correlations between regression change in LNs and clinicopathological characteristics, were analyzed. The prognostic effect of regression change and residual tumor groups in LNs was also analyzed. RESULTS We found that regression change and residual tumor groups in LNs were significantly correlated with regression change in the primary tumor, tumor differentiation, ypT stage, ypN stage, ypTNM stage, lymph-vascular invasion, perineural invasion and R0 resection status. Regression change and residual tumor groups in LNs were statistically significant using univariate Cox proportional hazards analysis, but were not independent predictors. For patients who had no residual tumor in LNs, the 5-year overall survival (OS) rates were 67.5% in Group A and 67.4% in Group B. For the patients who had residual tumors in LNs, the 5-year OS rates were 28.2% in Group C and 39.5% in Group D. The patients in Groups A+B had a significantly better outcome than the patients in Groups C+D ( P < 0.01). No significant differences in survival were found between Groups A and B, or between Groups C and D. CONCLUSION The existence of residual tumor in LNs, rather than regression change in LNs, is useful for predicting the prognosis after neoadjuvant chemotherapy in GAC patients. In practice, it may not be necessary to report regression change in LNs.

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“…In upper gastrointestinal cancers LN staging has a very high prognostic value [14]. For tumors treated with multimodal therapy, previous studies postulated that, not only the ypN status, but also the additional reporting and categorization of lymph node metastasis regression, may have important prognostic value [13,23,[29][30][31][32][33][34].…”

Section: Discussionmentioning

confidence: 99%

Tumor Regression in Lymph Node Metastases of Esophageal Adenocarcinomas after Neoadjuvant Therapy

Osecky

Kröll

Feith

et al. 2020

Gastrointestinal Disorders

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Tumor regression following neoadjuvant treatment can be observed in lymph node (LN) metastases similar to the primary tumor in esophageal adenocarcinomas (EAC). We evaluated the prognostic significance of tumor regression in LN metastases of locally advanced EAC of 239 patients treated with neoadjuvant radiochemotherapy (RCTX) or chemotherapy (CTX) followed by esophagectomy. We examined retrospectively the LN for histopathologic signs of regression, i.e., nodular fibrosis and acellular mucin. LN classification was performed according to two parameters: presence (−) or absence (+) of residual tumor and regression characteristics in the LN, resulting in four categories: LN−/REG−, LN−/REG+, LN+/REG+, LN+/REG−. In total, LN metastases with residual tumor were detectable in 117/239 (49%) cases. Regression in LN were observed in 85/239 cases (35.5%). The distribution of the LN/REG categories were as follows: 97 patients (40.6%) were LN−/REG−. A total of 25 patients (10.5%) were LN−/REG+. A total of 60 (25.1%) were LN+/REG+ and 57 (23.8%) LN+/REG−. The LN/Reg categorization had a significant prognostic value in univariate analysis (p < 0.001) and multivariate analysis (HR = 1.326; p = 0.002) with similar results for the subgroups of patients treated with RCTX or CTX. The prognosis of LN−/REG+ was worse than LN−/REG− but better than both LN+ categories, which was demonstrated in the Kaplan–Meier curves but did not reach statistical significance (p = 0.104 and p = 0.090, respectively). In contrast, there was no difference between LN+/REG+ and LN+/REG− (p = 0.802). In summary, regression in LN metastases of EAC can be observed in a significant number of patients after neoadjuvant therapy. Complete regression of former LN metastases in comparison to “true” negative LN seems to be of prognostic relevance but additional studies are needed to confirm this trend seen in our study.

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Prognostic significance of tumor regression in lymph nodes after neoadjuvant therapy for rectal carcinoma

Cited by 16 publications

References 19 publications

Significance of tumour regression in lymph node metastases of gastric and gastro‐oesophageal junction adenocarcinomas

Significance of tumour regression in lymph node metastases of gastric and gastro‐oesophageal junction adenocarcinomas

Unnecessity of lymph node regression evaluation for predicting gastric adenocarcinoma outcome after neoadjuvant chemotherapy

Tumor Regression in Lymph Node Metastases of Esophageal Adenocarcinomas after Neoadjuvant Therapy

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