The prognostic impact of neoadjuvant chemoradiotherapy on lymph node sampling in patients with locally advanced rectal cancer.
Giovanni Li DestriAndrea MaugeriAlice RamistellaGaetano La GrecaPietro ContiGiovanni TrombatoreGiada Maria VecchioGaetano Giuseppe MagroMartina BarchittaAntonella AgodiPublished in: Updates in surgery (2020)
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.
Keyphrases
- lymph node
- rectal cancer
- locally advanced
- prognostic factors
- neoadjuvant chemotherapy
- squamous cell carcinoma
- sentinel lymph node
- small cell lung cancer
- phase ii study
- radiation therapy
- case report
- newly diagnosed
- stem cells
- chronic kidney disease
- coronary artery disease
- patient reported outcomes
- papillary thyroid
- deep learning
- big data
- young adults
- childhood cancer
- percutaneous coronary intervention
- combination therapy