Predictors of Nodal Disease in Rectal Cancer Patients with Complete Mucosal Response to Neoadjuvant Therapy.
Journal
World journal of surgery
ISSN: 1432-2323
Titre abrégé: World J Surg
Pays: United States
ID NLM: 7704052
Informations de publication
Date de publication:
Aug 2023
Aug 2023
Historique:
accepted:
26
03
2023
medline:
3
7
2023
pubmed:
21
4
2023
entrez:
21
04
2023
Statut:
ppublish
Résumé
Some patients with locally advanced rectal cancer (LARC) achieve complete mucosal response following neoadjuvant therapy (NAT) and may be candidates for watch and wait strategy. This study aimed to identify predictors of nodal disease in patients with LARC who had a complete mucosal response to NAT. This case-control study included patients with LARC who were treated with NAT in the National Cancer Database between 2004 and 2019. Patients with complete mucosal response, defined as pathologic T0, were identified and classified according to the status of the pathologic N stage into complete response (pT0, pN0) and complete mucosal response with positive nodal disease (pT0, pN +). The two groups were compared regarding baseline demographics and tumor characteristics to determine the predictors of nodal disease after NAT. A total of 5529 patients (59.7% male) with a mean age of 59.6 ± 12.2 years had a complete mucosal response following NAT. Nodal disease was detected in 443 (8%) patients with a complete mucosal response. Independent predictors of nodal disease were clinical N + stage (OR: 1.87, p < 0.001), mucinous histology (OR: 3.8, p = 0.003), and lymphovascular invasion (OR = 4.01, p < 0.001). The clinical T stage was inversely related to the risk of nodal disease. Despite having a complete mucosal response following NAT, 8% of patients had nodal disease. Clinical evidence of nodal involvement on preoperative assessment, mucinous tumor histology, and lymphovascular invasion predicted nodal disease after NAT. These findings should be considered when making a decision on watch and wait strategy in patients with clinical complete response.
Sections du résumé
BACKGROUND
BACKGROUND
Some patients with locally advanced rectal cancer (LARC) achieve complete mucosal response following neoadjuvant therapy (NAT) and may be candidates for watch and wait strategy. This study aimed to identify predictors of nodal disease in patients with LARC who had a complete mucosal response to NAT.
METHODS
METHODS
This case-control study included patients with LARC who were treated with NAT in the National Cancer Database between 2004 and 2019. Patients with complete mucosal response, defined as pathologic T0, were identified and classified according to the status of the pathologic N stage into complete response (pT0, pN0) and complete mucosal response with positive nodal disease (pT0, pN +). The two groups were compared regarding baseline demographics and tumor characteristics to determine the predictors of nodal disease after NAT.
RESULTS
RESULTS
A total of 5529 patients (59.7% male) with a mean age of 59.6 ± 12.2 years had a complete mucosal response following NAT. Nodal disease was detected in 443 (8%) patients with a complete mucosal response. Independent predictors of nodal disease were clinical N + stage (OR: 1.87, p < 0.001), mucinous histology (OR: 3.8, p = 0.003), and lymphovascular invasion (OR = 4.01, p < 0.001). The clinical T stage was inversely related to the risk of nodal disease.
CONCLUSIONS
CONCLUSIONS
Despite having a complete mucosal response following NAT, 8% of patients had nodal disease. Clinical evidence of nodal involvement on preoperative assessment, mucinous tumor histology, and lymphovascular invasion predicted nodal disease after NAT. These findings should be considered when making a decision on watch and wait strategy in patients with clinical complete response.
Identifiants
pubmed: 37084107
doi: 10.1007/s00268-023-07012-6
pii: 10.1007/s00268-023-07012-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2013-2022Informations de copyright
© 2023. The Author(s) under exclusive licence to Société Internationale de Chirurgie.
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