Prognostic value of metastatic lymph node regression grade after neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer

Surgery ◽  
2019 ◽  
Vol 166 (6) ◽  
pp. 1061-1067
Author(s):  
Tetsuro Tominaga ◽  
Takashi Akiyoshi ◽  
Noriko Yamamoto ◽  
Koji Oba ◽  
Toshiya Nagasaki ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Prognostic Value ◽  
Metastatic Lymph Node ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Metastatic Lymph ◽  
Regression Grade

scholarly journals Prognostic Value of the Distribution of Lymph Node Metastasis in Locally Advanced Rectal Cancer After Neoadjuvant Chemoradiotherapy

2021 ◽  
Vol 8 ◽  
Author(s):  
Bin Chen ◽  
Xing Liu ◽  
Yiyi Zhang ◽  
Jinfu Zhuang ◽  
Yong Peng ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Prognostic Factor ◽  
Lymph Node Metastasis ◽  
Prognostic Value ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Node Metastasis

Background: The objective of this study is to assess the prognostic value of lymph node metastasis distribution (LND) in locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy (nCRT).Methods: This study included 179 patients with pathological stage III LARC who underwent nCRT followed by radical surgery. LND was classified into three groups: LND1, lymph node metastasis at the mesorectum (140/179, 78.2%); LND2, lymph node metastasis along the inferior mesenteric artery trunk nodes (26/179, 14.5%); LND3, lymph node metastasis at the origin of the IMA (13/179, 7.3%). Clinicopathologic characteristics were analyzed to identify independent prognostic factors.Result: LND showed better stratification for 3-year DFS (LND1 66.8, LND2 50, and LND3 15.4%, P < 0.01) compared to the ypN (3-year DFS: N1 59.9 and N2 60.3%, P = 0.34) and ypTNM (3-year DFS: IIIA 68.6%, IIIB 57.5%, and IIIC 53.5, P = 0.19) staging systems. Similar results were found for 3-year LRFS and DMFS. According to multivariate survival analysis, LND was shown to be an independent prognostic factor for DFS, LRFS, and DMFS in patients with positive lymph nodes (P < 0.01, in all cases).Conclusion: LND is an independent prognostic factor in stage III rectal cancer after nCRT. LND can be used as a supplementary indicator for the ypTNM staging system in patients with LARC after nCRT.

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

2020 ◽  
Vol 72 (3) ◽  
pp. 793-800 ◽  
Author(s):  
Giovanni Li Destri ◽  
Andrea Maugeri ◽  
Alice Ramistella ◽  
Gaetano La Greca ◽  
Pietro Conti ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Prognostic Impact ◽  
Metastatic Lymph Nodes ◽  
Metastatic Lymph ◽  
Lymph Node Retrieval

Abstract 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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