Prognostic importance of lymph node count and ratio in rectal cancer after neoadjuvant chemoradiotherapy: Results from a cross-sectional study.
chemoradiotherapy
disease-free survival
lymph nodes
rectal cancer
survival
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
revised:
08
04
2021
accepted:
24
04
2021
pubmed:
15
5
2021
medline:
24
8
2021
entrez:
14
5
2021
Statut:
ppublish
Résumé
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). 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
367-377Subventions
Organisme : AllerGen
Organisme : KWF Kankerbestrijding
Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
Sjo OH , Merok MA , Svindland A , Nesbakken A. Prognostic impact of lymph node harvest and lymph node ratio in patients with colon cancer. Dis Colon Rectum. 2012;55(3):307-315. https://doi.org/10.1097/DCR.0b013e3182423f62
Hall MD , Schultheiss TE , Smith DD , et al. Impact of total lymph node count on staging and survival after neoadjuvant chemoradiation therapy for rectal cancer. Ann Surg Oncol. 2015;22:580-587. https://doi.org/10.1245/s10434-015-4585-1
Amin MB , Greene FL , Edge SB , et al. The Eighth Edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017;67(2):93-99. https://doi.org/10.3322/caac.21388
Ng S-K , Lu C-T , Pakneshan S , Leung M , Siu S , Lam AK. Harvest of lymph nodes in colorectal cancer depends on demographic and clinical characteristics of the patients. Int J Colorectal Dis. 2018;33(1):19-22. https://doi.org/10.1007/s00384-017-2927-0
Lykke J , Jess P , Roikjaer O. A high lymph node yield in colon cancer is associated with age, tumour stage, tumour sub-site and priority of surgery. Results from a prospective national cohort study. Int J Colorectal Dis. 2016;31(7):1299-1305. https://doi.org/10.1007/s00384-016-2599-1
Okada K , Sadahiro S , Suzuki T , et al. The size of retrieved lymph nodes correlates with the number of retrieved lymph nodes and is an independent prognostic factor in patients with stage II colon cancer. Int J Colorectal Dis. 2015;30(12):1685-1693. https://doi.org/10.1007/s00384-015-2357-9
Mechera R , Schuster T , Rosenberg R , Speich B. Lymph node yield after rectal resection in patients treated with neoadjuvant radiation for rectal cancer: a systematic review and meta-analysis. Eur J Cancer. 2017;72:84-94. https://doi.org/10.1016/j.ejca.2016.10.031
Persiani R , Biondi A , Gambacorta MA , et al. Prognostic implications of the lymph node count after neoadjuvant treatment for rectal cancer. Br J Surg. 2014;101(2):133-142. https://doi.org/10.1002/bjs.9341
Mekenkamp LJM , Van Krieken JHJM , Marijnen CAM , Van De Velde CJH , Nagtegaal ID. Lymph node retrieval in rectal cancer is dependent on many factors-the role of the tumor, the patient, the surgeon, the radiotherapist, and the pathologist. Am J Surg Pathol. 2009;33(10):1547-1553. https://doi.org/10.1097/PAS.0b013e3181b2e01f
Baxter NN , Morris AM , Rothenberger DA , Tepper JE. Impact of preoperative radiation for rectal cancer on subsequent lymph node evaluation: a population-based analysis. Int J Radiat Oncol Biol Phys. 2005;61(2):426-431. https://doi.org/10.1016/j.ijrobp.2004.06.259
Bustamante-Lopez L , Nahas CS , Nahas SC , et al. Understanding the factors associated with reduction in the number of lymph nodes in rectal cancer patients treated by neoadjuvant treatment. Int J Colorectal Dis. 2017;32(6):925-927. https://doi.org/10.1007/s00384-016-2747-7
Rullier A , Laurent C , Capdepont M , et al. Lymph nodes after preoperative chemoradiotherapy for rectal carcinoma: number, status, and impact on survival. Am J Surg Pathol. 2008;32(1):45-50. https://doi.org/10.1097/PAS.0b013e3180dc92ab
Ha YH , Jeong S-Y , Lim S-B , et al. Influence of preoperative chemoradiotherapy on the number of lymph nodes retrieved in rectal cancer. Ann Surg. 2010;252(2):336-340. https://doi.org/10.1097/SLA.0b013e3181e61e33
Lykke J , Jess P , Roikjaer O .The prognostic value of lymph node ratio in a national cohort of rectal cancer patients. Eur J Surg Oncol. 2016;42(4):504-512. https://doi.org/10.1016/j.ejso.2016.01.012
Leonard D , Remue C , Abbes Orabi N , et al. Lymph node ratio and surgical quality are strong prognostic factors of rectal cancer: results from a single referral centre. Colorectal Disease. 2016;18(6):O175-O184. https://doi.org/10.1111/codi.13362
van Leersum NJ , Snijders HS , Henneman D , et al. The dutch surgical colorectal audit. Eur J Surg Oncol. 2013;39(10):1063-1070. https://doi.org/10.1016/j.ejso.2013.05.008
Dutch Snapshot Research G. Benchmarking recent national practice in rectal cancer treatment with landmark randomized controlled trials. Colorectal Disease. 2017;19(6):O219-O231. https://doi.org/10.1111/codi.13644
Peng J , Xu Y , Guan Z , et al. Prognostic significance of the metastatic lymph node ratio in node-positive rectal cancer. Ann Surg Oncol. 2008;15(11):3118-3123. https://doi.org/10.1245/s10434-008-0123-8
Zeng W-G , Zhou Z-X , Wang Z , et al. Lymph node ratio is an independent prognostic factor in node positive rectal cancer patients treated with preoperative chemoradiotherapy followed by curative resection. Asian Pacific J Cancer Prev. 2014;15(13):5365-5369. https://doi.org/10.7314/APJCP.2014.15.13.5365
Koo T , Song C , Kim J-S , et al. Impact of lymph node ratio on oncologic outcomes in ypStage III rectal cancer patients treated with neoadjuvant chemoradiotherapy followed by total mesorectal excision, and postoperative adjuvant chemotherapy. PLOS One. 2015;10(9):e0138728. https://doi.org/10.1371/journal.pone.0138728
Zuo Z-G , Zhang X-F , Wang H , et al. Prognostic value of lymph node ratio in locally advanced rectal cancer patients after preoperative chemoradiotherapy followed by total mesorectal excision. Medicine. 2016;95(9):e2988. https://doi.org/10.1097/MD.0000000000002988
Lee SD , Kim TH , Kim DY , et al. Lymph node ratio is an independent prognostic factor in patients with rectal cancer treated with preoperative chemoradiotherapy and curative resection. Eur J Surg Oncol. 2012;38(6):478-483. https://doi.org/10.1016/j.ejso.2012.03.002
Awwad GEH , Tou SIH , Rieger NA. Prognostic significance of lymph node yield after long-course preoperative radiotherapy in patients with rectal cancer: a systematic review. Colorectal Disease. 2013;15(4):394-403. https://doi.org/10.1111/codi.12011
Bustamante-Lopez LA , Nahas CSR , Nahas SC , et al. Pathologic complete response implies a fewer number of lymph nodes in specimen of rectal cancer patients treated by neoadjuvant therapy and total mesorectal excision. Int J Surg. 2018;56:283-287. https://doi.org/10.1016/j.ijsu.2018.07.001
Govindarajan A , Gönen M , Weiser MR , et al. Challenging the feasibility and clinical significance of current guidelines on lymph node examination in rectal cancer in the era of neoadjuvant therapy. J Clin Oncol. 2011;29(34):4568-4573. https://doi.org/10.1200/JCO.2011.37.2235
Kim HJ , Jo JS , Lee SY , Kim CH , Kim YJ , Kim HR. Low lymph node retrieval after preoperative chemoradiation for rectal cancer is associated with improved prognosis in patients with a good tumor response. Ann Surg Oncol. 2015;22(6):2075-2081. https://doi.org/10.1245/s10434-014-4235-z
Berho M , Oviedo M , Stone E , et al. The correlation between tumour regression grade and lymph node status after chemoradiation in rectal cancer. Colorectal Disease. 2009;11(3):254-258. https://doi.org/10.1111/j.1463-1318.2008.01597.x
Dias AR , Pereira MA , de Mello ES , Nahas SC , Cecconello I , Ribeiro U. Lymph node yield after neoadjuvant chemoradiotherapy in rectal cancer specimens. Dis Colon Rectum. 2018;61(8):1-896. https://doi.org/10.1097/DCR.0000000000001097
Tranchart H , Lefèvre JH , Svrcek M , Flejou J-F , Tiret E , Parc Y. What is the incidence of metastatic lymph node involvement after significant pathologic response of primary tumor following neoadjuvant treatment for locally advanced rectal cancer? Ann Surg Oncol. 2013;20(5):1551-1559. https://doi.org/10.1245/s10434-012-2773-9
Dekker JWT , Peeters KC , Putter H , Vahrmeijer AL , Van De Velde CJH. Metastatic lymph node ratio in stage III rectal cancer; prognostic significance in addition to the 7th edition of the TNM classification. Eur J Surg Oncol. 2010;36(12):1180-1186. https://doi.org/10.1016/j.ejso.2010.09.007
Ceelen W , Willaert W , Varewyck M , et al. Effect of neoadjuvant radiation dose and schedule on nodal count and its prognostic impact in stage II-III rectal cancer. Ann Surg Oncol. 2016;23(12):3899-3906. https://doi.org/10.1245/s10434-016-5363-4
Fulop ZZ , Gurzu S , Bara T , et al. Lymph node ratio, an independent prognostic factor for patients with stage II-III rectal carcinoma. Pathol Res Pract. 2019;215(6):152384. https://doi.org/10.1016/j.prp.2019.03.013
Park IJ , Yu CS , Lim S-B , et al. Ratio of metastatic lymph nodes is more important for rectal cancer patients treated with preoperative chemoradiotherapy. World J Gastroenterol. 2015;21(11):3274-3281. https://doi.org/10.3748/wjg.v21.i11.3274
Kang J , Hur H , Min BS , Lee KY , Kim NK. Prognostic impact of the lymph node ratio in rectal cancer patients who underwent preoperative chemoradiation. J Surg Oncol. 2011;104(1):53-58. https://doi.org/10.1002/jso.21913
Hong YS , Nam BH , Kim KP , et al. Oxaliplatin, fluorouracil, and leucovorin versus fluorouracil and leucovorin as adjuvant chemotherapy for locally advanced rectal cancer after preoperative chemoradiotherapy (ADORE): an open-label, multicentre, phase 2, randomised controlled trial. Lancet Oncol. 2014;15(11):1245-1253. https://doi.org/10.1016/S1470-2045(14)70377-8