Lymph Node Yield Is a Less Reliable Prognostic Marker Following Neoadjuvant Chemoradiotherapy Compared to Primary Surgery for Rectal Cancer

Abstract Introduction International guidelines recommend a minimum lymph node yield (LNY) of ≥12 for oncological resection in colorectal cancer (CRC). Neoadjuvant chemoradiotherapy (NACRT) decreases LNY, which questions its ability to provide accurate prognostic information. The consensus of this significance remains undetermined. This study aimed to investigate the significance of LNY on recurrence and survival following anterior resection and abdominoperineal resection with or without NACRT for rectal cancer. Method Prospectively collected data on patients diagnosed with rectal cancer in a tertiary referral centre was interrogated retrospectively. Patients were divided into primary surgery and NACRT groups. Univariable analysis was performed using Fisher's exact test, t-test, and x2 test, while multivariable analysis utilised a multiple regression model. Disease recurrence and survival was analysed with logrank test for Kaplan-Meier curves. Result 148 patients were included [56.1% (n=83) receiving NACRT]. The median LNY of the primary surgery group was 14 [interquartile range (IQR) 11-19] and for the NACRT group was 12 (IQR 8-14) (p <0.001). Disease recurrence was similar in both primary surgery and NACRT groups. There was a significant decrease in overall mortality in NACRT patients (p = 0.03), but there was no significant difference observed in recurrence or mortality amongst LNYs of <8, 8-11, and ≥12. Conclusion LNY less than 12 was not a negative prognostic indicator following NACRT and surgery for rectal cancer. Take-home message A lymph node yield of less than 12 is not a negative prognostic indicator in rectal cancer patients who receive neoadjuvant chemotherapy.

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Can Ex Vivo Magnetic Resonance Imaging of Rectal Cancer Specimens Improve the Mesorectal Lymph Node Yield for Pathological Examination?

Investigative Radiology ◽

10.1097/rli.0000000000000581 ◽

2019 ◽

Vol 54 (10) ◽

pp. 645-652 ◽

Cited By ~ 3

Author(s):

Rutger Stijns ◽

Bart Philips ◽

Carla Wauters ◽

Johannes de Wilt ◽

Iris Nagtegaal ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Rectal Cancer ◽

Lymph Node ◽

Magnetic Resonance ◽

Ex Vivo ◽

Pathological Examination ◽

Resonance Imaging ◽

Lymph Node Yield ◽

Mesorectal Lymph Node ◽

Node Yield

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Lymph node yield in rectal cancer surgery: Effect of preoperative chemoradiotherapy

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2009.12.006 ◽

2010 ◽

Vol 36 (4) ◽

pp. 345-349 ◽

Cited By ~ 60

Author(s):

B. Morcos ◽

B. Baker ◽

M. Al Masri ◽

H. Haddad ◽

S. Hashem

Keyword(s):

Rectal Cancer ◽

Lymph Node ◽

Preoperative Chemoradiotherapy ◽

Cancer Surgery ◽

Rectal Cancer Surgery ◽

Lymph Node Yield ◽

Node Yield

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Lymph node yield is an independent predictor of survival in rectal cancer regardless of receipt of neoadjuvant therapy

Journal of Clinical Pathology ◽

10.1136/jclinpath-2016-203995 ◽

2016 ◽

Vol 70 (7) ◽

pp. 584-592 ◽

Cited By ~ 16

Author(s):

Zhaomin Xu ◽

Mariana E Berho ◽

Adan Z Becerra ◽

Christopher T Aquina ◽

Bradley J Hensley ◽

...

Keyword(s):

Rectal Cancer ◽

Lymph Node ◽

Neoadjuvant Therapy ◽

Neoadjuvant Treatment ◽

Neoadjuvant Chemoradiation ◽

Mixed Effects ◽

Patient Factors ◽

Lymph Node Yield ◽

Factors Associated ◽

Node Yield

AimsLymph node yield (LNY) is used as a marker of adequate oncological resection. The American Joint Committee on Cancer (AJCC) currently recommends that at least 12 nodes are necessary to confirm node-negative disease for rectal cancer. A LNY of 12 is not always achieved, particularly in patients who have undergone neoadjuvant treatment. This study attempts to examine factors associated with LNY and its prognostic impact following neoadjuvant chemoradiation in rectal cancer.MethodsThe 2006–2011 National Cancer Data Base was queried for patients with clinical stage I–III rectal cancer who underwent a proctectomy. Suboptimal LNY was defined as <12 lymph nodes examined. A mixed-effects multinomial logistic regression model was used to identify independent factors associated with LNY. Mixed-effects Cox proportional hazards models were used to estimate the adjusted effect of LNY on 5-year overall survival.Results25 447 patients met inclusion criteria. Overall, 62% of the cohort received neoadjuvant chemoradiation and 32% had suboptimal LNY. The median LNY for patients who received neoadjuvant therapy was 13 (IQR: 9–18) and for patients who did not receive neoadjuvant therapy was 15 (IQR: 12–21). After risk adjustment, there was a 3.5-fold difference in the rate of suboptimal LNY among individual hospitals (27%–95%). Suboptimal LNY was independently associated with an 18% increased hazard of death among patients who did not receive neoadjuvant treatment and a 20% increased hazard of death among those who did receive neoadjuvant treatment when controlled for adjuvant treatment, staging, proximal/distal margins and other patient factors.ConclusionsSuboptimal LNY is independently associated with worse overall survival regardless of neoadjuvant therapy, pathological staging and patient factors in rectal cancer. This finding underlies the importance and challenge of an optimal lymph node evaluation for prognostication, especially for patients receiving neoadjuvant therapy.

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