Prediction model for ypΝ status after preoperative chemoradiotherapy in patients with rectal cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 513-513 ◽  
Author(s):  
Eunjin Jwa ◽  
Jong Hoon Kim ◽  
Seungbong Han ◽  
Jin-hong Park ◽  
Jin Cheon Kim ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Prediction Model ◽  
Cancer Patients ◽  
Local Excision ◽  
Preoperative Chemoradiotherapy ◽  
Lymph Node Status ◽  
Node Metastasis ◽  
Nodal Stage

513 Background: Pelvic lymph node status after preoperative chemoradiotherapy (CRT) is not only an important indicator for oncologic outcome but critical information to determine the type of a subsequent surgical resection (i.e. curative surgery or local excision) in patients with locally advanced rectal cancer. The purpose of this study is to develop a nomogram to predict the lymph node status after preoperative CRT in rectal cancer patients whose ypT information is available. Methods: Using logistic regression analyses, we constructed a prediction model to predict the probability of lymph node metastasis after preoperative CRT in a cohort of 1,099 patients with rectal cancer treated with preoperative CRT and total mesorectal excision (TME) from 2007 to 2011. The model was internally validated for discrimination and calibration using bootstrap resampling. Results: Pretreatment clinical nodal stage, distant metastasis, pre- and post-treatment tumor differentiation, and ypT stage were reliable predictors for lymph node metastasis after preoperative CRT. The nomogram developed using these parameters represents a valid and accurate method for predicting lymph node metastasis after preoperative CRT in rectal cancer patients. (c-index: 0.75) Patients with low pretreatment nodal stage, nonmetastatic, and well differentiated rectal adenocarcinoma downstaged to ypT0-1 after preoperative CRT will have low chance of pelvic lymph node involvement. Conclusions: Our model is expected to assist clinicians in quantifying the benefit of radical resection and finding out the patient group who can be treated with local excision after preoperative CRT for rectal cancer.

scholarly journals Comparison between Local Excision and Radical Resection for the Treatment of Rectal Cancer in ypT0-1 Patients: An Analysis of the Clinicopathological Factors and Survival Rates

Cancers ◽  
2021 ◽  
Vol 13 (19) ◽  
pp. 4823
Author(s):  
Soo Young Oh ◽  
In Ja Park ◽  
Young IL Kim ◽  
Jong-Lyul Lee ◽  
Chan Wook Kim ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Local Excision ◽  
Survival Rates ◽  
Oncologic Outcome ◽  
Radical Resection ◽  
Preoperative Chemoradiotherapy ◽  
Node Metastasis ◽  
Significant Difference

Tumors with good response to preoperative chemoradiotherapy have a favorable prognosis, and these findings raise interest in rectum-sparing strategies. This study aimed to compare the oncologic outcome between local excision and radical resection in ypT0-1 patients and to analyze prognostic factors. Patients with primary rectal cancer diagnosed with ypT0-1 after PCRT followed by either radical resection (RR) or local excision (LE) between 2005 and 2014 were included in this study (LE = 78, RR = 442). Clinicopathologic features, recurrence-free survival (RFS), and OS were analyzed. There was no statistically significant difference in the RFS and OS between the LE and RR groups. Clinical T stage (cT3-4) before PCRT was related to RFS and in the LE group (p = 0.022). Lymph node metastasis (HR: 4.884, 95% confidence interval: 2.451–9.732, p < 0.001) in the final pathology was the only factor associated with RFS, showing a statistically significant difference in the RR group. Lymph node metastasis and age were associated with OS in the RR group. This study confirms the oncologic feasibility of LE in ypT0-1 rectal cancer after PCRT. Additionally, careful patient selection with higher accuracy modalities should be updated to improve treatment outcomes of LE.

scholarly journals Extracapsular Extension Does Not Decrease Overall Survival in Rectal Cancer Patients with Lymph Node Metastasis Following Neoadjuvant Chemoradiotherapy

2020 ◽  
Vol 11 (2) ◽  
pp. 11-19
Author(s):  
Leonardo Lino-Silva ◽  
Carmen Sánchez-Acosta ◽  
Rosa Salcedo-Hernández ◽  
César Zepeda-Najar
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Cancer Patients ◽  
Perineural Invasion ◽  
Neoadjuvant Chemoradiotherapy ◽  
Stage Iii ◽  
Node Metastasis ◽  
Nodal Stage

Background. The Tumor-Node-Metastasis system does not include additional prognostic factors present in the Lymph Node Metastasis (LNM) such as extra-capsular extension (ECE), which is associated with decreased survival. There are not studies addressing this topic in rectal cancer patients with preoperative chemoradiotherapy (nCRT) and total mesorectal excision (TME). Aim. We aimed to examine the survival influence of ECE in patients with stage III rectal cancer who received nCRT followed by surgery. Methods. A retrospective study of 126 patients prospectively collected with rectal cancer in clinical stage III rated with nCRT and TME from 2010 to 2015 was performed. Results. In total, 71.6% of cases had 1 to 3 lymph node metastases, most tumors were grade 2 (52.4%), 25.4% had good pathologic response, 77.8% had a good quality TME, and the median tumor budding count was 4/0.785 mm2. Forty-four (34.9%) patients had ECE+, which was associated with a higher nodal stage (pN2), perineural invasion and a higher lymph node retrieval. The factors associated with the survival were a higher pathologic T stage, higher pathological N stage, high-grade tumors, and perineural invasion. The ECE did not decrease the 5–year survival with a similar median survival (86.5 months for the ECE+ group vs. 84.1 for the ECE–). Conclusion. Our results demonstrate that ECE has no impact on overall survival in rectal cancer patients who received nCRT and this was independent of nodal stage or number of lymph nodes examined.

P11 Risk factors of lymph node metastasis in rectal cancer following preoperative chemoradiotherapy

2014 ◽  
Vol 50 ◽  
pp. S12-S13
Author(s):  
J.W. Park ◽  
J.H. Oh ◽  
E.G. Youk ◽  
S.-B. Kang ◽  
S.C. Heo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Preoperative Chemoradiotherapy ◽  
Node Metastasis

scholarly journals Analysis of Risk Factors for Lymph Nodal Involvement in Early Stages of Rectal Cancer: When Can Local Excision Be Considered an Appropriate Treatment? Systematic Review and Meta-Analysis of the Literature

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Alessandro Carrara ◽  
Daniela Mangiola ◽  
Riccardo Pertile ◽  
Alberta Ricci ◽  
Michele Motter ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Local Excision ◽  
Radical Surgery ◽  
Meta Analysis ◽  
Nodal Involvement ◽  
Node Metastasis ◽  
Early Stages

Background. Over the past ten years oncological outcomes achieved by local excision techniques (LETs) as the sole treatment for early stages of rectal cancer (ESRC) have been often disappointing. The reasons for these poor results lie mostly in the high risk of the disease's diffusion to local-regional lymph nodes even in ESRC.Aims. This study aims to find the correct indications for LET in ESRC taking into consideration clinical-pathological features of tumours that may reduce the risk of lymph node metastasis to zero.Methods. Systematic literature review and meta-analysis of casistics of ESRC treated with total mesorectal excision with the aim of identifying risk factors for nodal involvement.Results. The risk of lymph node metastasis is higher inG≥2andT≥2tumours with lymphatic and/or vascular invasion. Other features which have not yet been sufficiently investigated include female gender, TSM stage >1, presence of tumour budding and/or perineural invasion.Conclusions. Results comparable to radical surgery can be achieved by LET only in patients with T1N0G1tumours with low-risk histological features, whereas deeper or more aggressive tumours should be addressed by radical surgery (RS).

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