Increased lymph node yield indicates improved survival in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy
Abstract Purpose It is recommended for colorectal cancer to harvest at least 12 lymph nodes (LNs) during surgery to avoid understaging of the disease. However, it is still controversial whether it is necessary to harvest from locally advanced rectal cancer (LARC) patients who underwent neoadjuvant c...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-08-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.2372 |
| _version_ | 1797847716757241856 |
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| author | Yaqi Wang Menglong Zhou Jianing Yang Xiaoyang Sun Wei Zou Zhiyuan Zhang Jing Zhang Lijun Shen Lifeng Yang Zhen Zhang |
| author_facet | Yaqi Wang Menglong Zhou Jianing Yang Xiaoyang Sun Wei Zou Zhiyuan Zhang Jing Zhang Lijun Shen Lifeng Yang Zhen Zhang |
| author_sort | Yaqi Wang |
| collection | DOAJ |
| description | Abstract Purpose It is recommended for colorectal cancer to harvest at least 12 lymph nodes (LNs) during surgery to avoid understaging of the disease. However, it is still controversial whether it is necessary to harvest from locally advanced rectal cancer (LARC) patients who underwent neoadjuvant chemoradiotherapy (neo‐CRT). The impact of lymph node yield (LNY) on prognosis in LARC patients was analyzed. Materials/Methods In total, 495 LARC patients who underwent neo‐CRT in 2006‐2015 were analyzed. After examining clinicopathological distribution differences between the LNY subgroups (with the threshold of 12), univariate and multivariate Cox survival analyses were performed. Survival plots were obtained from Kaplan‐Meier analyses. Similar subgroup analyses were performed according to the tumor regression grade (TRG) and metastatic status of post‐operational LNs. Results Of the 495 patients, 287 (57.98%) had an LNY of less than 12. Nearly no significant clinicopathological difference was found between the LNY subgroups, including the TRG scores. Multivariate survival analysis demonstrated that at least 12 LNs examined was an independent prognostic feature of good overall survival (OS), disease‐free survival (DFS), and distant metastasis free survival (DMFS), but not local recurrence free survival (LRFS). However, in the subgroup analyses, no association was found between LNY and prognosis in patients with good TRG scores (0‐1) or negative LNs. Conclusions For LARC patients treated with neo‐CRT, an LNY of at least 12 indicated an improved survival. Decreased LNY was not related to better tumor regression. It suggests that a sufficiently high LNY is still required, especially in those with a potentially poor tumor response. |
| first_indexed | 2024-04-09T18:15:53Z |
| format | Article |
| id | doaj.art-9c06aaa546694361bbdac74e1c64f3a1 |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-04-09T18:15:53Z |
| publishDate | 2019-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-9c06aaa546694361bbdac74e1c64f3a12023-04-13T04:36:19ZengWileyCancer Medicine2045-76342019-08-018104615462510.1002/cam4.2372Increased lymph node yield indicates improved survival in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapyYaqi Wang0Menglong Zhou1Jianing Yang2Xiaoyang Sun3Wei Zou4Zhiyuan Zhang5Jing Zhang6Lijun Shen7Lifeng Yang8Zhen Zhang9Department of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai PR ChinaDepartment of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai PR ChinaDepartment of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai PR ChinaDepartment of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai PR ChinaDepartment of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai PR ChinaDepartment of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai PR ChinaDepartment of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai PR ChinaDepartment of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai PR ChinaDepartment of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai PR ChinaDepartment of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai PR ChinaAbstract Purpose It is recommended for colorectal cancer to harvest at least 12 lymph nodes (LNs) during surgery to avoid understaging of the disease. However, it is still controversial whether it is necessary to harvest from locally advanced rectal cancer (LARC) patients who underwent neoadjuvant chemoradiotherapy (neo‐CRT). The impact of lymph node yield (LNY) on prognosis in LARC patients was analyzed. Materials/Methods In total, 495 LARC patients who underwent neo‐CRT in 2006‐2015 were analyzed. After examining clinicopathological distribution differences between the LNY subgroups (with the threshold of 12), univariate and multivariate Cox survival analyses were performed. Survival plots were obtained from Kaplan‐Meier analyses. Similar subgroup analyses were performed according to the tumor regression grade (TRG) and metastatic status of post‐operational LNs. Results Of the 495 patients, 287 (57.98%) had an LNY of less than 12. Nearly no significant clinicopathological difference was found between the LNY subgroups, including the TRG scores. Multivariate survival analysis demonstrated that at least 12 LNs examined was an independent prognostic feature of good overall survival (OS), disease‐free survival (DFS), and distant metastasis free survival (DMFS), but not local recurrence free survival (LRFS). However, in the subgroup analyses, no association was found between LNY and prognosis in patients with good TRG scores (0‐1) or negative LNs. Conclusions For LARC patients treated with neo‐CRT, an LNY of at least 12 indicated an improved survival. Decreased LNY was not related to better tumor regression. It suggests that a sufficiently high LNY is still required, especially in those with a potentially poor tumor response.https://doi.org/10.1002/cam4.2372locally advanced rectal cancerlymph node yieldneoadjuvant chemoradiotherapyprognosistumor regression grade |
| spellingShingle | Yaqi Wang Menglong Zhou Jianing Yang Xiaoyang Sun Wei Zou Zhiyuan Zhang Jing Zhang Lijun Shen Lifeng Yang Zhen Zhang Increased lymph node yield indicates improved survival in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy Cancer Medicine locally advanced rectal cancer lymph node yield neoadjuvant chemoradiotherapy prognosis tumor regression grade |
| title | Increased lymph node yield indicates improved survival in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy |
| title_full | Increased lymph node yield indicates improved survival in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy |
| title_fullStr | Increased lymph node yield indicates improved survival in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy |
| title_full_unstemmed | Increased lymph node yield indicates improved survival in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy |
| title_short | Increased lymph node yield indicates improved survival in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy |
| title_sort | increased lymph node yield indicates improved survival in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy |
| topic | locally advanced rectal cancer lymph node yield neoadjuvant chemoradiotherapy prognosis tumor regression grade |
| url | https://doi.org/10.1002/cam4.2372 |
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