Lateral node metastasis in low rectal cancer as a hallmark to predict recurrence patterns.

Lateral node metastasis Local recurrence Prognosis Recurrence in extra-regional nodes Stage III low rectal cancer

Journal

International journal of clinical oncology
ISSN: 1437-7772
Titre abrégé: Int J Clin Oncol
Pays: Japan
ID NLM: 9616295

Informations de publication

Date de publication:
14 Oct 2024
Historique:
received: 30 06 2024
accepted: 17 09 2024
medline: 15 10 2024
pubmed: 15 10 2024
entrez: 14 10 2024
Statut: aheadofprint

Résumé

Lateral node metastasis confers a poor prognosis in rectal cancer. Several multidisciplinary treatments have been proposed with favorable outcomes. However, appropriate neoadjuvant/adjuvant treatments or follow-up plans based on information about the probable recurrence site have not been specified. We aimed to clarify the distinctive features of recurrence patterns for lateral node-positive low rectal cancer according to the lateral and mesorectal lymph node status. We retrospectively analyzed 508 patients with stage III low rectal cancer who underwent lateral node dissection. We investigated the impact of lateral and mesorectal lymph node status on site-specific recurrence rates and patient survival. Analyses for relapse-free survival revealed the prognostic impact of lateral node positivity in stage III low rectal cancer (p < 0.0001). Lateral node-positive patients exhibited higher risk of overall recurrence, local recurrence, and recurrence in extra-regional nodes than lateral node-negative patients (p < 0.0001, p = 0.001, and p < 0.0001, respectively). However, lateral node positivity was not statistically associated with a hematogenous recurrence rate. In lateral node-positive patients, both tumor-node-metastasis (TNM)-N status and number of lateral nodes involved were revealed as significant prognostic factors (p < 0.0001, both). In addition, the number of lateral nodes involved could be a discriminatory indicator of probabilities of local recurrence and recurrence in extra-regional nodes (p = 0.02, and p < 0.0001, respectively). Lateral node-positive low rectal cancer exhibits higher local recurrence and extra-regional node recurrence rates that correlate with the number of lateral nodes involved.

Sections du résumé

BACKGROUND BACKGROUND
Lateral node metastasis confers a poor prognosis in rectal cancer. Several multidisciplinary treatments have been proposed with favorable outcomes. However, appropriate neoadjuvant/adjuvant treatments or follow-up plans based on information about the probable recurrence site have not been specified. We aimed to clarify the distinctive features of recurrence patterns for lateral node-positive low rectal cancer according to the lateral and mesorectal lymph node status.
METHODS METHODS
We retrospectively analyzed 508 patients with stage III low rectal cancer who underwent lateral node dissection. We investigated the impact of lateral and mesorectal lymph node status on site-specific recurrence rates and patient survival.
RESULTS RESULTS
Analyses for relapse-free survival revealed the prognostic impact of lateral node positivity in stage III low rectal cancer (p < 0.0001). Lateral node-positive patients exhibited higher risk of overall recurrence, local recurrence, and recurrence in extra-regional nodes than lateral node-negative patients (p < 0.0001, p = 0.001, and p < 0.0001, respectively). However, lateral node positivity was not statistically associated with a hematogenous recurrence rate. In lateral node-positive patients, both tumor-node-metastasis (TNM)-N status and number of lateral nodes involved were revealed as significant prognostic factors (p < 0.0001, both). In addition, the number of lateral nodes involved could be a discriminatory indicator of probabilities of local recurrence and recurrence in extra-regional nodes (p = 0.02, and p < 0.0001, respectively).
CONCLUSIONS CONCLUSIONS
Lateral node-positive low rectal cancer exhibits higher local recurrence and extra-regional node recurrence rates that correlate with the number of lateral nodes involved.

Identifiants

DOI: 10.1007/s10147-024-02630-z PMID: 39402391
pubmed: 39402391
doi: 10.1007/s10147-024-02630-z
pii: 10.1007/s10147-024-02630-z
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024. The Author(s) under exclusive licence to Japan Society of Clinical Oncology.

Références

Brierley J, Gospodarowicz M, Wittekind C (2017) TNM classification of malignant tumors, 8th edn. Wiley-Blackwell, West Sussex
Kanemitsu Y, Komori K, Shida D et al (2017) Potential impact of lateral lymph node dissection (LLND) for low rectal cancer on prognoses and local control: a comparison of 2 high-volume centers in Japan that employ different policies concerning LLND. Surgery 162:303–314
doi: 10.1016/j.surg.2017.02.005 pubmed: 28366499
Akiyoshi T, Watanabe T, Miyata S et al (2012) Results of a Japanese nationwide multi-institutional study on lateral pelvic lymph node metastasis in low rectal cancer: is it regional or distant disease? Ann Surg 255:1129–1134
doi: 10.1097/SLA.0b013e3182565d9d pubmed: 22549752
Yamai D, Shimada Y, Nakano M et al (2023) Clinical significance of metastatic tumor deposit foci in rectal cancer in the lateral pelvic lymph node area. Int J Clin Oncol 28:1388–1397
doi: 10.1007/s10147-023-02391-1 pubmed: 37481501
Hiyoshi Y, Miyamoto Y, Kiyozumi Y et al (2020) Risk factors and prognostic significance of lateral pelvic lymph node metastasis in advanced rectal cancer. Int J Clin Oncol 25:110–117
doi: 10.1007/s10147-019-01523-w pubmed: 31407167
Oki E, Ando K, Kasagi Y et al (2015) Recent advances in multidisciplinary approach for rectal cancer. Int J Clin Oncol 20:641–649
doi: 10.1007/s10147-015-0858-8 pubmed: 26100273
Geppert B, Lönnerfors C, Bollino M et al (2017) A study on uterine lymphatic anatomy for standardization of pelvic sentinel lymph node detection in endometrial cancer. Gynecol Oncol 145:256–261
doi: 10.1016/j.ygyno.2017.02.018 pubmed: 28196672
Yuen K, Miura T, Sakai I et al (2015) Intraoperative fluorescence imaging for detection of sentinel lymph nodes and lymphatic vessels during open prostatectomy using indocyanine green. J Urol 194:371–377
doi: 10.1016/j.juro.2015.01.008 pubmed: 25584996
Akaike H (1973) Information theory and extension of the maximum likelihood principle. In: Kotz S, Johnson NL (eds) Breakthroughs in statistics. Foundations and basic theory, vol 1. Springer-Verlag, New York, pp 610–624
Shinto E, Ike H, Ito M et al (2022) Optimizing nodal and staging classification in low rectal cancers with lateral node metastasis: multicentre retrospective cohort study. BJS Open 6:006
doi: 10.1093/bjsopen/zrac006
Ogura A, Konishi T, Cunningham C et al (2019) Neoadjuvant (Chemo)radiotherapy with total mesorectal excision only is not sufficient to prevent lateral local recurrence in enlarged nodes: results of the multicenter lateral node study of patients with low cT3/4 rectal cancer. J Clin Oncol 37:33–43
doi: 10.1200/JCO.18.00032 pubmed: 30403572
Akiyoshi T, Toda S, Tominaga T et al (2019) Prognostic impact of residual lateral lymph node metastasis after neoadjuvant (chemo)radiotherapy in patients with advanced low rectal cancer. BJS Open 3:822–829
doi: 10.1002/bjs5.50194 pubmed: 31832589
Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740
doi: 10.1056/NEJMoa040694 pubmed: 15496622
Peeters KCMJ, Marijnen CAM, Nagtegaal ID et al (2007) The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246:693–701
doi: 10.1097/01.sla.0000257358.56863.ce pubmed: 17968156
Schrag D, Weiser MR, Goodman KA et al (2014) Neoadjuvant chemotherapy without routine use of radiation therapy for patients with locally advanced rectal cancer: a pilot trial. J Clin Oncol 32:513–518
doi: 10.1200/JCO.2013.51.7904 pubmed: 24419115
Fernandez-Martos C, Brown G, Estevan R et al (2014) Preoperative chemotherapy in patients with intermediate-risk rectal adenocarcinoma selected by high-resolution magnetic resonance imaging: the GEMCAD 0801 Phase II multicenter trial. Oncologist 19:1042–1043
doi: 10.1634/theoncologist.2014-0233 pubmed: 25209376
Patel UB, Brown G, Machado I et al (2017) MRI assessment and outcomes in patients receiving neoadjuvant chemotherapy only for primary rectal cancer: long-term results from the GEMCAD 0801 trial. Ann Oncol 28:344–353
doi: 10.1093/annonc/mdw616 pubmed: 28426108
Hamaguchi T, Shirao K, Moriya Y et al (2011) Final results of randomized trials by the national surgical adjuvant study of colorectal cancer (NSAS-CC). Cancer Chemother Pharmacol 67:587–596
doi: 10.1007/s00280-010-1358-1 pubmed: 20490797
Gérard JP, Azria D, Gourgou-Bourgade S et al (2012) Clinical outcome of the accord 12/0405 PRODIGE 2 randomized trial in rectal cancer. J Clin Oncol 30:4558–4565
doi: 10.1200/JCO.2012.42.8771 pubmed: 23109696
Fernandez-Martos C, Garcia-Albeniz X, Pericay C et al (2015) Chemoradiation, surgery and adjuvant chemotherapy versus induction chemotherapy followed by chemoradiation and surgery: long-term results of the Spanish GCR-3 phase II randomized trial†. Ann Oncol 26:1722–1728
doi: 10.1093/annonc/mdv223 pubmed: 25957330
Ciseł B, Pietrzak L, Michalski W et al (2019) Long-course preoperative chemoradiation versus 5 × 5 Gy and consolidation chemotherapy for clinical T4 and fixed clinical T3 rectal cancer: long-term results of the randomized Polish II study. Ann Oncol 30:1298–1303
doi: 10.1093/annonc/mdz186 pubmed: 31192355

Auteurs

Eiji Shinto (E)

Department of Surgery, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, Tokyo, 154-8532, Japan. eiji-c@zf6.so-net.ne.jp.
ORCID: 0000-0002-1046-1789

Hideyuki Ike (H)

Department of Surgery, JCHO Yokohama Hodogaya Central Hospital, 43-1 Kamadai, Hodogaya, Yokohama, Kanagawa, Japan.

Masaaki Ito (M)

Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, Japan.

Keiichi Takahashi (K)

Department of Surgery, Tokyo Metropolitan Health and Hospitals Corporation Ohkubo Hospital, 2-44-1 Kabuki, Shinjyuku, Tokyo, Japan.

Masayuki Ohue (M)

Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo, Osaka, Japan.

Yukihide Kanemitsu (Y)

Department of Colorectal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo, Tokyo, Japan.

Takeshi Suto (T)

Department of Gastroenterological Surgery, Yamagata Prefectural Central Hospital, Aoyagi, Yamagata, 1800, Japan.

Tetsushi Kinugasa (T)

Fukuokamitsuki Hospital, 1-2-1 Befu, Jonan, Fukuoka, Japan.

Jun Watanabe (J)

Department of Colorectal Surgery, Kansai Medical University, 5-1 Shinmachi 2 Chome, Hirakata, Osaka, Japan.

Jin-Ichi Hida (JI)

Department of Surgery, Kindai University Nara Hospital, Otoda, Ikoma, Nara, 1248-1, Japan.

Michio Itabashi (M)

Saiseikai Kazo Hospital, Kamitakayanagi, Kazo, Saitama, 1680, Japan.

Heita Ozawa (H)

Department of Colorectal Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, Japan.

Hiroaki Nozawa (H)

Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, Japan.

Yojiro Hashiguchi (Y)

Department of Surgery, Omori Red Cross Hospital, 4-30-1 Chuo, Ota, Tokyo, Japan.

Kazuo Hase (K)

Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, Japan.

Kenichi Sugihara (K)

Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, Japan.

Yoichi Ajioka (Y)

Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University, 757 Ichibancho, Asahimachi-dori, Chuo Ward, Niigata, Japan.

Classifications MeSH