Impact factors of lymph node retrieval on survival in locally advanced rectal cancer with neoadjuvant therapy.
Mei Shi-Wen,Liu Zheng,Wang Zheng,Pei Wei,Wei Fang-Ze,Chen Jia-Nan,Wang Zhi-Jie,Shen Hai-Yu,Li Juan,Zhao Fu-Qiang,Wang Xi-Shan,Liu Qian
World journal of clinical cases
BACKGROUND:Conventional clinical guidelines recommend that at least 12 lymph nodes should be removed during radical rectal cancer surgery to achieve accurate staging. The current application of neoadjuvant therapy has changed the number of lymph node dissection. AIM:To investigate factors affecting the number of lymph nodes dissected after neoadjuvant chemoradiotherapy in locally advanced rectal cancer and to evaluate the relationship of the total number of retrieved lymph nodes (TLN) with disease-free survival (DFS) and overall survival (OS). METHODS:A total of 231 patients with locally advanced rectal cancer from 2015 to 2017 were included in this study. According to the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) tumor-node-metastasis (TNM) classification system and the NCCN guidelines for rectal cancer, the patients were divided into two groups: group A (TLN ≥ 12, = 177) and group B (TLN < 12, = 54). Factors influencing lymph node retrieval were analyzed by univariate and binary logistic regression analysis. DFS and OS were evaluated by Kaplan-Meier curves and Cox regression models. RESULTS:The median number of lymph nodes dissected was 18 (range, 12-45) in group A and 8 (range, 2-11) in group B. The lymph node ratio (number of positive lymph nodes/total number of lymph nodes) ( = 0.039) and the interval between neoadjuvant therapy and radical surgery ( = 0.002) were independent factors of the TLN. However,TLN was not associated with sex, age, ASA score, clinical T or N stage, pathological T stage, tumor response grade (Dworak), downstaging, pathological complete response, radiotherapy dose, preoperative concurrent chemotherapy regimen, tumor distance from anal verge, multivisceral resection, preoperative carcinoembryonic antigen level, perineural invasion, intravascular tumor embolus or degree of differentiation. The pathological T stage ( < 0.001) and TLN ( < 0.001) were independent factors of DFS, and pathological T stage ( = 0.011) and perineural invasion ( = 0.002) were independent factors of OS. In addition, the risk of distant recurrence was greater for TLN < 12 ( = 0.009). CONCLUSION:A shorter interval to surgery after neoadjuvant chemoradiotherapy for rectal cancer under indications may cause increased number of lymph nodes harvested. Tumor shrinkage and more extensive lymph node retrieval may lead to a more favorable prognosis.
Pathological response post neoadjuvant therapy for locally advanced rectal cancer is an independent predictor of survival.
On Jason,Shim Joanna,Mackay Craig,Murray Graeme,Samuel Leslie,Parnaby Craig,Ramsay George
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
BACKGROUND:Neoadjuvant treatment (NaT) for locally advanced rectal cancer prior to surgery has led to improved outcomes. However, the relationship between pathological response to NaT and survival is not entirely clear. The aim of this study was to assess the degree of pathological response to NaT on survival outcomes. METHODS:Clinical and pathological data were collected from a prospectively maintained pathology database between 2005 and 2017. The primary outcome was the overall survival based on pathological response categorized as complete, good partial, partial and minimal. Univariate and multivariate analysis were conducted to identify variables predictive of survival. Cox proportional hazard ratios were used for survival. RESULTS:A total of 596 patients had surgery following NaT for locally advanced rectal cancer. The median follow-up was 4.57 years (IQR 2.21-8.15 years). The overall survival for complete pathological response was 75.6% versus 37.3% for minimal response (p <0.001). The overall survival at the end of the study in the good partial versus partial response group was 58.9% versus 39%, (p <0.001). On multivariate analysis, the degree of pathological response remains an independent variable for overall and disease specific survival across all categories. DISCUSSION:In addition to other pathological variables, the degree of pathological response to NaT is an independent predictor for survival outcomes. Future verification of these findings elsewhere could support NaT response being used for adjuvant therapy decision making.