scholarly journals Loco-regional N staging in Rectal Cancer with Magnetic Resonance Imaging: A Study of Inter- and Intra-Observer Variability

2021 ◽  
Author(s):  
Luca Pio Stoppino ◽  
Alessia Francavilla ◽  
Miriana Rosaria Petrera ◽  
Maria Grazia Rita Manco ◽  
Matteo Gravina ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Nodes ◽  
Interobserver Reliability ◽  
Rectal Adenocarcinoma ◽  
The United States ◽  
The Other ◽  
Intraobserver Reproducibility ◽  
Significant Difference ◽  
Abdominal Mri ◽  
N Staging

Abstract Background: Colorectal cancer is one of the most common tumors for both men and women: in the United States, it represents the third leading cause of new cancer cases and cancer-related deaths. The prognosis is directly related to tumor infiltration in the mesorectum and lymph node metastases. In particular, it’s important to define the distance between lymphadenopathy and mesorectal fascia, as this has repercussions on surgical planning. This study aimed to evaluate the agreement among observers with different abdominal MRI expertise and intra-observer reliability in lymph nodes size and feature definition. Methods: In this retrospective study, MRI examinations were performed in 88 patients with rectal adenocarcinoma treated with primary surgery. Four observers, two senior physicians, and two junior physicians, analyzed MRI scans in two sessions 30 days apart and determined the size and morphological pattern of regional lymph nodes. Statistical analysis included the determination of Fleiss kappa (k) coefficient, Cohen's Kappa coefficient, and confidence intervals (CI). Results: The inter-observer reproducibility for MRI N-staging was good among the four physicians (kappa = 0.65; CI 0.45–0.77). Reproducibility between the two senior physicians had a kappa of 0.68 (CI 0.62–1.00), while between the two junior physicians had a kappa of 0.61 (CI 0.33–0.89). Inter-observer reproducibility was excellent for mesorectal, inferior mesenteric, and internal iliac lymph nodes (kappa values of 0.89, 0.82, and 0.80 respectively). For the other two nodal stations (superior and middle rectal lymph nodes, sacral lymph nodes), there was a good interobserver reproducibility (kappa between 0.70 and 0.77).The intra-observer reproducibility of interpretations of the MRI overall N staging progressively decreased among observer B (kappa= 0.85), observer C (kappa= 0.59), and the other two physicians. There was a significant difference in lymph nodes measurements between the first and second sessions in observer A (p ≥ 0.05). Excellent intraobserver reproducibility was found for mesorectal lymph nodes; the lowest intraobserver reproducibility values were found for presacral and lateral sacral lymph nodes.Conclusions: Although the low accuracy of MRI in assessing the involvement of metastatic lymph nodes in rectal cancer, this study demonstrates good interobserver reliability among physicians with different abdominal MRI experiences.

Effect of chemoradiotherapy (CRT) for rectal cancer on the lymph nodes (LNs): Exploration of the number of retrieved LNs, number of metastatic LNs, and the size of LNs.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 651-651 ◽  
Author(s):  
Kazutake Okada ◽  
Sotaro Sadahiro ◽  
Toshiyuki Suzuki ◽  
Akira Tanaka ◽  
Hiroko Okamura ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Colon Cancer ◽  
Lymph Nodes ◽  
Radiation Field ◽  
Radical Surgery ◽  
Rectal Adenocarcinoma ◽  
Short Axis ◽  
Degree Of Reduction ◽  
Group 4 ◽  
Significant Difference

651 Background: For accurate staging of colon cancer, 12 or more LNs are recommended to be explored. Although the total number of LNs in rectal cancer was reported to be decreased after CRT, the number of LNs to be explored is not yet clear. We investigated the number of retrieved LNs, number of metastatic LNs, and the LN sizes within the radiation field in comparison with those outside the radiation field, to clarify the influence of CRT. Methods: The subjects were 211 patients with cStage II/III rectal adenocarcinoma who underwent radical surgery between 1991 and 2010. Of these, 111 patients underwent surgery alone (S group) and 100 patients also received preoperative CRT (40 or 45Gy) with concurrent oral UFT or S-1 (RT-group). The numbers of LNs were reviewed by pathological chart, and HE-stained specimens were examined with a digitizer to evaluate the LN sizes (short-axis, long-axis and area). Results: A total of 2049 LNs were retrieved, of which 230 were metastatic LNs. The average number of retrieved LNs was significantly higher in the S group (16±11) than that in the RT group (9±7) (P < 0.0001). The number of LNs inside the radiation field was significantly higher in the S group (6±6) than that in the RT group (4±4) (P = 0.001), whereas outside the radiation field, there was no significant difference between the two groups (5±4 in the S group vs. 5±4 in the RT group). The short-axis of the retrieved LNs was significantly larger in the S group (within the radiation field: 3.5±2.1 mm in the S group vs. 3.0±1.9 mm in the RT group, P < 0.0001; outside the radiation field: 4.3±2.6 in the S group vs. 3.8±2.4 in the RT group, P = 0.05). Conclusions: Preoperative CRT significantly decreased the total number of LNs compared to the surgery alone, attributable to the decrease in the number of LNs inside the radiation field. CRT reduced the size of the LNs and the degree of reduction was larger in the nodes within the radiation field than in those outside. And it was suggested that CRT also had an effect on the LNs outside the radiation field.

CCTG CO.28 primary endpoint analysis: Neoadjuvant chemotherapy, excision and observation for early rectal cancer, the NEO trial.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 3508-3508
Author(s):  
Hagen Fritz Kennecke ◽  
Carl J Brown ◽  
Jonathan M. Loree ◽  
Husein Moloo ◽  
Derek J. Jonker ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
High Risk ◽  
Tumor Progression ◽  
Primary Endpoint ◽  
Organ Preservation ◽  
Rectal Adenocarcinoma ◽  
The United States ◽  
High Rate ◽  
Pelvic Mri ◽  
Preservation Rate

3508 Background: CO.28 (NCT03259035) is a phase II study designed to determine if patients with cT1-T3a/bN0 rectal cancer can be treated with induction chemotherapy (FOLFOX/CAPOX) and organ-preserving surgery. Methods: Patients with MRI staged cT1-3a/bN0 tumors and no pathologic (p) high risk features received 6/4 cycles of FOLFOX/CAPOX, repeat sigmoidoscopy/pelvic MRI and subsequent Transanal Endoscopic Surgery (TES) in the absence of tumor progression. ypT0/T1N0 tumors were treated with observation while ypT2+ or ypN+ stage were recommended Total Mesorectal Excision (TME). The primary endpoint was protocol specified Organ Preservation Rate (psOPR = ypT0/T1N0, no p high risk features) and actual Organ Preservation Rate (aOPR = ypT0/T1N0 stage plus higher yp stage patients who declined TME surgery). The study would be considered negative with an psOPR of 50% or lower (H0) and as promising if it is 65% or higher (H1). Results: Between 08/2017 to 05/2020, 58 eligible patients were accrued in Canada and the United States, median age was 67 years, 71% male. All had well-moderately differentiated, non-mucinous rectal adenocarcinoma and median tumor height was 6 cm (range 0-18). Median follow-up was 15.4 months. Chemotherapy with FOLFOX (32) or CAPOX (26) was administered, 90% completed all planned cycles. A total of 56/58 (97%) proceeded to TES, while one patient was ineligible due to tumor progression (1.7%) and one declined. In the intention to treat analysis, the psOPR was 57% (95% CI 43-70%) while the aOPR was 79% (95% CI 67% to 89%) due to 13/23 declining recommended TME surgery. Of 10 patients who proceeded to recommended TME, a complete R0 TME was performed in 9/10, and no p residual carcinoma was found in 7/10. Crude loco-regional (LR) and distant recurrence rates were 3.5% (95% CI 0.4 to 12%) and 0%, respectively. A recurrence occurred in 1/13 patients who initially declined TME surgery. Conclusions: In select patients with early stage rectal cancer, three months of induction CAPOX/FOLFOX followed by TES resulted in a high OPR without the use of pelvic irradiation. The observed high rate of pathologic downstaging may point to high chemo-responsiveness in early rectal adenocarcinoma with no p high risk features. Further trials to evaluate this approach are justified and updated results will be presented. Clinical trial information: NCT03259035. [Table: see text]

Role of adjuvant chemotherapy following chemoradiation and surgery for locoregionally advanced rectal cancer: A Veterans Health Administration analysis.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 741-741
Author(s):  
Daphna Spiegel ◽  
Matthew Boyer ◽  
Julian C. Hong ◽  
Christina D. Williams ◽  
Michael J. Kelley ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Registry ◽  
Single Agent ◽  
Advanced Rectal Cancer ◽  
The United States ◽  
Stage Ii ◽  
Health Administration ◽  
Significant Difference ◽  
Multi Agent

741 Background: Adjuvant chemotherapy (AC) following chemoradiation (CRT) and total mesorectal excision (TME) for locoregionally advanced rectal cancer (LARC) is a standard of care in the United States despite limited data. The purpose of this study was to examine the role, optimal regimen, and duration of AC in the mandatory, prospectively collected cancer registry of the largest integrated health system in the US. Methods: Using the VA Central Cancer Registry, stage II-III rectal cancer patients diagnosed between 1/2001-4/2011 were included if they received neoadjuvant CRT followed by TME with or without AC. Adequate chemotherapy was defined as at least 4 months of therapy. Kaplan-Meier and Log-Rank tests were used to assess survival. Propensity score (PS) adjustment was performed to compare survival outcomes while adjusting for baseline characteristics, including AJCC stage, age, gender, race, smoking status, and comorbidity. Results: 649 patients were identified; 323 received AC while 326 did not (OBS). Median follow-up was 66 months. Mean age was 63 years. 85.1% were white; 98.8% were male. 49.2% had stage II disease. Median overall survival (OS) for all patients was 92 months; 6-year OS was 56.8%. Median OS was 72 months for the OBS group and not reached (NR) for the AC group (p < 0.001). OS at 6 years was 49.5% for OBS and 64.1% for AC (p < 0.0001). On PS matched analysis, OS was improved favoring AC (p < 0.0001). Median disease-specific survival (DSS) was NR for the whole group and NR for the OBS and AC groups. 6-year DSS was 73.6% for the whole group and 67.9% for OBS vs. 79.2% for AC (p < 0.001). PS matched analysis for DSS favored AC (p = 0.0004). There was no significant difference in OS (p = 0.554) or DSS (p = 0.680) when comparing single versus multi-agent chemotherapy and no significant difference in OS (p = 0.766) or DSS (p = 0.271) when comparing adequate ( > / = 4 months) versus inadequate chemotherapy ( < 4 months). Conclusions: In this VA population of LARC patients treated with neoadjuvant CRT followed by TME, the addition of AC was found to improve both OS and DSS compared to OBS. There was no improvement in OS or DSS with the addition of a multi-agent over single-agent chemotherapy.

Chemoradiation-induced alteration of programmed death-ligand 1 and CD8+ tumor-infiltrating lymphocytes in rectal cancer.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 570-570
Author(s):  
Marina Baretti ◽  
Wei Fu ◽  
Hao Wang ◽  
Robert A Anders ◽  
Nilofer Saba Azad ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Checkpoint Inhibitors ◽  
Rectal Adenocarcinoma ◽  
Neoadjuvant Chemoradiotherapy ◽  
Tumor Infiltrating Lymphocytes ◽  
Tumor Stroma ◽  
Immune Checkpoints ◽  
Mucin Expression ◽  
Significant Difference ◽  
Potential Applicability

570 Background: DNA damage and subsequent neoantigen formation has been hypothesized as a mechanismfor radiotherapy and PD-1/PD-L1 pathway inhibition to synergize in an antitumor immune response. We investigated neoadjuvant chemoradiotherapy (nCRT)-induced changes in CD8+ tumor infiltrating lymphocyte, PD-L1 and mucin expression in rectal cancer patients as compared to patients who did not receive nCRT. Methods: Tumor samples were collected from rectal adenocarcinoma patients who had undergone resection between 2008-2014 with (n = 62) or without (n = 17) nCRT treatment. Tissue sections were stained with CD8 and PD-L1 antibodies for immunohistochemistry. Whole slides images were acquired at 20x magnification. The prevalence of positive CD8 stained cells was recorded in tumor, interface tumor side, interface background rectal side. Image analysis (HALO Indica Labs) was used to determine the density (# of cells/surface area analyzed) of CD8 expressing lymphocytes. The percentage of PD-L1 membranous expression was manually counted in tumor cells (TC), tumor stroma (TS) and invasive front (IF). Mucin expression was determined as the percentage of the mucin area in the whole tumor mass area. Results: PD-L1 expression on TCs was identified in 7.7 % (6/78) of specimens. All 6 cases had received nCRT (p = 0.33). 80% and 75.5% of the nCRT cases showed PD-L1 expression on TS and IF respectively, versus 20% (p = 0.55) and 24.5% (p = 0.56) in non-nCRT cases. The median densities of CD8+ infiltrating T lymphocytes in tumor, interface tumor side, interface background rectal side did not differ significantly between the two groups (p = 0.79, p = 0.47, p = 0.22). No nCRT-changes in mucin expression observed in the 28 evaluable cases (p = 0.25). Conclusions: nCRT exposure was associated with a non-significant difference in PD-L1 expression on TS and IF cells in patients with rectal adenocarcinoma as compared to non-nCRT case, possibly due to sample size limitations. Further mechanistic investigations and comprehensive analysis of other immune checkpoints are needed to understand nCRT-induced immunologic shift in rectal cancer and to expand the potential applicability of checkpoint inhibitors in this setting.

scholarly journals Rectal cancer: a methodological approach to matching PET/MRI to histopathology

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Miriam K. Rutegård ◽  
Malin Båtsman ◽  
Lennart Blomqvist ◽  
Martin Rutegård ◽  
Jan Axelsson ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Nodes ◽  
Imaging Modality ◽  
Methodological Approach ◽  
Neoadjuvant Treatment ◽  
Rectal Adenocarcinoma ◽  
Cancer Trial ◽  
Surgical Specimen ◽  
Tumour Spread ◽  
The Impact

Abstract Purpose To enable the evaluation of locoregional disease in the on-going RECTOPET (REctal Cancer Trial on PET/MRI/CT) study; a methodology to match mesorectal imaging findings to histopathology is presented, along with initial observations. Methods FDG-PET/MRI examinations were performed in twenty-four consecutively included patients with rectal adenocarcinoma. In nine patients, of whom five received neoadjuvant treatment, a postoperative MRI of the surgical specimen was performed. The pathological cut-out was performed according to clinical routine with the addition of photo documentation of each slice of the surgical specimen, meticulously marking the location, size, and type of pathology of each mesorectal finding. This allowed matching individual nodal structures from preoperative MRI, via the specimen MRI, to histopathology. Results Preoperative MRI identified 197 mesorectal nodal structures, of which 92 (47%) could be anatomically matched to histopathology. Of the matched nodal structures identified in both MRI and histopathology, 25% were found to be malignant. These malignant structures consisted of lymph nodes (43%), tumour deposits (48%), and extramural venous invasion (9%). One hundred eleven nodal structures (55%) could not be matched anatomically. Of these, 97 (87%) were benign lymph nodes, and 14 (13%) were malignant nodal structures. Five were malignant lymph nodes, and nine were tumour deposits, all of which had a short axis diameter < 5 mm. Conclusions We designed a method able to anatomically match and study the characteristics of individual mesorectal nodal structures, enabling further research on the impact of each imaging modality. Initial observations suggest that small malignant nodal structures assessed as lymph nodes in MRI often comprise other forms of mesorectal tumour spread. Trial registration Clinical Trials Identifier:NCT03846882.

Does up-front definitive surgical resection with delayed chemotherapy in patients with stage IV rectal cancer compromise overall survival?

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 586-586
Author(s):  
Bindu V. Manyam ◽  
Shlomo A. Koyfman ◽  
Davendra Sohal ◽  
Ismail Mallick ◽  
Chandana A. Reddy ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Surgical Resection ◽  
Proportional Hazards ◽  
Performance Status ◽  
Rectal Adenocarcinoma ◽  
Stage Iv ◽  
Cox Proportional Hazards ◽  
Significant Difference ◽  
Poorly Differentiated

586 Background: Definitive resection of the primary is frequently part of the management of patients (pts) with stage IV rectal cancer with good performance status and low volume of systemic metastases. It is unclear whether delaying systemic therapy for up front surgical management of the primary compromises overall survival (OS). Methods: Pts with metastatic rectal adenocarcinoma who received definitive surgical resection between 1998-2011 were identified in an IRB approved registry. The sequencing of CT and surgery, and the use of perioperative radiation therapy (RT), was at the discretion of treating physicians. Preoperative chemotherapy (Pre-CT) regimens included 5-fluorouracil (5-FU) +/- leukovorin (LV), capecitabine, 5-FU/LV/oxaliplatin +/- avastin, or 5-FU/LV/irinocetan. RT dose was typically 50.4 Gy. OS was measured from the date of diagnosis. Baseline variables were compared using the Chi-square and unpaired t-tests. OS was calculated using the Kaplan Meier method. Univariate (UVA) and multivariate analysis (MVA) were performed using Cox proportional hazards regression to identify variables associated with OS. Results: In this study of 115 pts, 75 (65%) were treated with pre-CT, while 40 (35%) were treated with up front surgery. Of the pts who received surgery up front, 3 (8%) received RT and of the pts who received pre-CT, 62 (83%) received RT. The cohort was predominantly male (70%) with a median age of 57, median KPS of 80, and median follow-up of 24.1 months. 94% of pts had T3/T4 tumors, 80% had N+ disease, and 33% had poorly differentiated tumors. Liver directed therapy (LDT) was performed in 61% of pts. There was no significant difference in OS (32.3 vs. 32 months; p = 0.24) between pts treated with pre-CT and those who received surgery up front, respectively. UVA demonstrated that pre-CT was not associated with OS (HR 1.26; p = 0.544). MVA demonstrated that pts with poorly differentiated tumors (HR 2.04; p = 0.007) and those that did not undergo LDT (HR 2.45; p = 0.001) had inferior survival. Conclusions: Delaying systemic chemotherapy in order to achieve local control with surgical resection up front does not appear to impact OS in pts with stage IV rectal cancer.

Comparison of shear-wave velocities obtained with shear-wave elastography of various peripheral lymph nodes in healthy Beagles

2021 ◽  
Vol 82 (12) ◽  
pp. 981-987
Author(s):  
Kang Yu-rim ◽  
Lee Su-hyeon ◽  
Seo Im-mee ◽  
Ko Jae-un ◽  
Kim Jae-hwan ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Shear Wave ◽  
Clinical Relevance ◽  
Interobserver Reliability ◽  
Shear Wave Elastography ◽  
The Other ◽  
Wave Velocities ◽  
Shear Wave Velocities ◽  
Peripheral Lymph

Abstract OBJECTIVE To compare shear-wave velocities (SWVs) with shear-wave elastography of various peripheral lymph nodes (LNs). ANIMALS 11 healthy Beagles. PROCEDURES For each dog, bilateral mandibular, medial retropharyngeal, superficial cervical, axillary, superficial inguinal, and popliteal LNs were evaluated with shear-wave elastography in sagittal and transverse scanning planes. Depth of each lymph node was recorded, and intra- and interobserver reliability was determined. RESULTS SWVs for all LNs were significantly higher in the sagittal scanning plane, compared with those in the transverse scanning plane. The SWV of the most superficial LN, the mandibular LN, was significantly higher, compared with that for the other LNs, except for the medial retropharyngeal LN. The SWV of the deepest LN, the medial retropharyngeal LN, was as high as that for the mandibular LN. Intra- and interobserver reliability was excellent. CONCLUSIONS AND CLINICAL RELEVANCE SWVs for normal peripheral LNs of Beagles may serve as a reference to compare with those for other breeds and diseased LNs. Scanning plane, LN depth, and interfering tissues between the LN and the transducer may affect SWV. Shear-wave elastography may not be operator dependent.

scholarly journals Application of Diffusion Kurtosis Imaging and Histogram Analysis for Assessing Preoperative Stages of Rectal Cancer

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Hui Xie ◽  
Guangyao Wu
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Rectal Adenocarcinoma ◽  
Area Under The Curve ◽  
Histogram Analysis ◽  
Diffusion Kurtosis Imaging ◽  
Diagnostic Efficiency ◽  
Significant Difference ◽  
Adc Values ◽  
Diffusion Kurtosis

Objective. To explore the value of diffusion kurtosis imaging (DKI) and histogram analysis for assessing preoperative stages and heterogeneity in rectal cancer. Methods. Fifty patients with pathologically confirmed rectal adenocarcinoma were enrolled. The value of DKI parameters and histogram metrics for assessing the preoperative stages and heterogeneity in rectal cancer was analyzed retrospectively. Results. (1) ADC-10th percentile and ADC-25th percentile were significantly higher in T1-2 than in the T3-4 rectal cancer (the ADC values were 0.65 ± 0.08 × 10−3 mm2/s versus 0.58 ± 0.11 × 10−3 mm2/s and 0.73 ± 0.11 × 10−3 mm2/s versus 0.65 ± 0.11 × 10−3 mm2/s; p values were 0.035 and 0.024, resp.). (2) D-10th percentile and D-25th percentile were also significantly higher in T1-2 than in T3-4 rectal cancer (the D values were 0.96 ± 0.19 × 10−3 mm2/s versus 0.84 ± 0.16 × 10−3 mm2/s and 1.15 ± 0.27 × 10−3 mm2/s versus 0.99 ± 0.18 × 10−3 mm2/s; p values were 0.017 and 0.044, resp.). (3) K value and its histogram metrics showed no statistically significant difference between T1-2 and T3-4. (4) D-10th had the largest area under the curve (AUC 0.799) among all the parameters; the sensitivity and specificity were 84.2 and 61.3%, respectively. (5) DKI combined with traditional MRI had an accuracy of 68% while assessing the lymph node of rectal cancer. Conclusion. DKI parameters and histogram metrics are rather valuable in assessing the preoperative stages of rectal cancer; D-10th percentile exhibits the highest diagnostic efficiency.

Analysis of new N descriptors on prognosis of esophageal cancer with positive lymph nodes in a Chinese population.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14678-e14678
Author(s):  
Yaping Xu
Keyword(s):  
Decision Making ◽  
Esophageal Cancer ◽  
Adjuvant Therapy ◽  
Lymph Nodes ◽  
Staging System ◽  
Postoperative Adjuvant Therapy ◽  
Cox Regression Analysis ◽  
Significant Difference ◽  
N Staging ◽  
Positive Lymph Nodes

e14678 Background: The 7th edition of the American Joint Committee on Cancer / Union International Against Cancer (AJCC/UICC) TNM staining system for esophageal cancer (EC) has been published. N descriptors are now divided into N0, N1, N2 and N3. In this study, we aimed to validate the prognostic ability of the new N staging system in patients with resectable EC and positive lymph nodes, and evaluate whether the new N staging system can help the decision-making for postoperative adjuvant therapy in this population. Methods: From 2002 to 2008, patients with stage T1-4N1-3M0 EC who underwent esophagectomy were retrospectively analyzed. EC was classified according to the new N staging system. Kaplan-Meier method and Cox regression analysis were employed to compare overall survival (OS). Results: A total of545 patients met the inclusion criteria: 346 (63.5%) received esophagectomy alone, 199 (36.5%) received esophagectomy and adjuvant radiotherapy, and 36.1% (197/545) received esophagectomy and adjuvant chemotherapy. Univariate analysis and multivariate analysis revealed significant difference in OS among patients with EC at different N stages (p<0.001). Significant difference in OS was also present among patients receiving radiotherapy (p<0.001) and those undergoing chemotherapy (p<0.001). Subgroup analysis indicated that postoperative adjuvant therapy did not significantly affect the OS among patients with EC at different N stages. Conclusions: Our results validated the prognostic ability of new N staging system. N descriptor is an independent prognostic factor in patients with resectable EC who were positive for lymph nodes. Further studies are required to clarify the role of new N staging system in the decision-making for postoperative adjuvant therapy in this population.

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