Understanding the factors associated with reduction in the number of lymph nodes in rectal cancer patients treated by neoadjuvant treatment

Bustamante-Lopez, Leonardo Alfonso; Nahas, Caio Sérgio Rizkallah; Nahas, Sérgio Carlos; Ribeiro, Ulysses; Marques, Carlos Frederico Sparapan; Cotti, Guilherme Cutait de Castro; Rocco, A.; Cecconello, Ivan

doi:10.1007/s00384-016-2747-7

Cited by 19 publications

(29 citation statements)

References 12 publications

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“…We also found that patients in the NACRT group had significantly fewer metastatic lymph nodes than patients in the no-NACRT group. Consensus in the literature varies in terms of the relationship between the number of metastatic lymph nodes and prognosis [3,4,25]. In our study, patients who underwent NACRT tended to have a better (although not significantly so) 5-year DFS (80.3% versus 73.2%) (Fig.…”

Section: Discussionmentioning

confidence: 57%

“…An accurate pathologic assessment of lymph nodes is crucial to ensure correct LARC staging and management, and it is the strongest predictor of long-term outcomes [3,4,11,16]. The AJCC recommends that at least 12 lymph nodes are retrieved to establish patient prognosis [13].…”

Section: Discussionmentioning

confidence: 99%

“…In our analyses, patient sex, the distance between the tumor and the anus, interval time, tumor stage, and tumor regression grade did not affect the number of lymph nodes retrieved, whereas patient age and NACRT significantly reduced the number of lymph nodes in surgical samples (Table 3). No consensus on the effects of these parameters on lymph node sampling exists in the literature [3,5,11].…”

Section: Discussionmentioning

confidence: 99%

“…Approximately, 75% of patients with colorectal cancer undergo radical treatment [1]. Neoadjuvant chemoradiation therapy (NACRT) followed by total mesorectal excision (TME) has become the treatment of choice for patients with stage II-III locally advanced rectal cancer (LARC) [2][3][4][5][6]. Data from a randomized clinical trial performed in 2004 showed that TME preceded by chemoradiation was safer and more effective than TME with no prior treatment in patients with LARC [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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The prognostic impact of neoadjuvant chemoradiotherapy on lymph node sampling in patients with locally advanced rectal cancer

Maugeri

Ramistella

et al. 2020

Updates Surg

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According to the American Joint Committee on Cancer, at least 12 lymph nodes are required to accurately stage locally advanced rectal cancer (LARC). Neoadjuvant chemoradiation therapy (NACRT) reduces the number of lymph nodes retrieved during surgery. In this study, we evaluated the effect of NACRT on lymph node retrieval and prognosis in patients with LARC. We performed an observational study of 142 patients with LARC. Although our analysis was retrospective, data were collected prospectively. Half the patients were treated with NACRT and total mesorectal excision (TME) and the other half underwent TME only. The number of lymph nodes retrieved and the number of metastatic lymph nodes were significantly reduced in the NACRT group (P > 0.001). In the univariate and multivariate analyses, only NACRT and patient age were significantly associated with reduced lymph node retrieval. The number of metastatic lymph nodes and the lymph node ratio (LNR) both had a significant effect on prognosis when the patient population was examined as a whole (P = 0.003 and P = 0.001, respectively). However, the LNR was the only significant, independent prognostic factor in both treatment groups (P = 0.007 for the NACRT group; P = 0.04 for the no-NACRT group). NACRT improves patient prognosis only when the number of metastatic lymph nodes is reduced. The number of metastatic lymph nodes and the LNR are important prognostic factors. Lymph node retrieval remains an indispensable tool for staging and prognostic assessment of patients with rectal carcinoma treated with NACRT.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The prognostic impact of neoadjuvant chemoradiotherapy on lymph node sampling in patients with locally advanced rectal cancer

Maugeri

Ramistella

et al. 2020

Updates Surg

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“…Several studies have shown that NAT was frequently associated with decreased number of harvested lymph nodes, regardless of the application of TME principle and appropriate pathologic evaluation [20][21][22][23]. Moreover, some of the findings also noted that retrieval of less than 12 lymph nodes in the proctectomy specimen of rectal cancer treated with NAT had no adverse effect on long-term survival and may be a marker of higher tumor response [24][25][26][27]. In our multivariate analysis, the number of harvested lymph nodes was one of the independent predictors of PFS.…”

Section: Discussionmentioning

confidence: 99%

Influence of Tumor Location on Short- and Long-Term Outcomes After Laparoscopic Surgery for Rectal Cancer: A Propensity Score Matched Cohort Study

Yang

Yao

Cui

et al. 2020

Preprint

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Background: This study aimed to evaluate the short- and long-term outcomes after laparoscopic resection for low rectal cancer (LRC) compared with mid/high rectal cancer (M/HRC). Methods: Patients with rectal cancer undergoing laparoscopic resection with curative intent were retrospectively reviewed between 2009 and 2015. After matched 1:1 by using propensity score analysis, perioperative and oncological outcomes were compared between LRC and M/HRC groups. Multivariate analysis was performed to identify independent factors of overall survival (OS) and disease-free survival (DFS). Results: Of 373 patients who met the criteria for inclusion, 260 patients were matched for the analysis. Laparoscopic surgery for LRC required longer operative time (P＜0.001) and more blood loss volume (P＜0.001) compared with M/HRC, and the LRC group tended to have a higher incidence of postoperative complications (18.5% vs. 10.0%, P=0.051). There was no significant difference in local recurrence between the two groups (6.2% vs. 2.3%, P=0.216), whereas distant metastasis was more frequent in LRC patients compared with M/HRC (19.2% vs. 9.2%, P=0.021). The LRC group showed significantly inferior 5-year OS (78.1% vs. 88.8%, P=0.008) and DFS (76.2% vs. 89.0%, P=0.004) compared with the M/HRC group. Multivariate analysis indicated that tumor location was an independent predictor of OS (HR=2.095, 95% CI 1.142-3.843, P=0.017) and DFS (HR=2.320, 95% CI 1.251-4.303, P=0.008). Conclusion: Tumor location of the rectal cancer significantly affected the clinical and oncological outcomes after laparoscopic surgery, and it was an independent predictor of OS and DFS.

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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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Understanding the factors associated with reduction in the number of lymph nodes in rectal cancer patients treated by neoadjuvant treatment

Abstract: The tumor regression grade is the most important factor for the decrease in the number of lymph nodes.

Cited by 19 publications

References 12 publications

The prognostic impact of neoadjuvant chemoradiotherapy on lymph node sampling in patients with locally advanced rectal cancer

The prognostic impact of neoadjuvant chemoradiotherapy on lymph node sampling in patients with locally advanced rectal cancer

Influence of Tumor Location on Short- and Long-Term Outcomes After Laparoscopic Surgery for Rectal Cancer: A Propensity Score Matched Cohort Study

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

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