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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2015

01-06-2015 | Colorectal Cancer

Low Lymph Node Retrieval After Preoperative Chemoradiation for Rectal Cancer is Associated with Improved Prognosis in Patients with a Good Tumor Response

Authors: Hun Jin Kim, MD, Jeong Seon Jo, MD, Soo Young Lee, MD, Chang Hyun Kim, MD, Young Jin Kim, MD, PhD, Hyeong Rok Kim, MD, PhD

Published in: Annals of Surgical Oncology | Issue 6/2015

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Abstract

Purpose

To examine the association between the number of lymph nodes retrieved and oncologic outcome after preoperative chemoradiation for rectal cancer according to tumor regression grade.

Methods

Patients with rectal cancer who underwent curative surgery between May 2004 and December 2012 were analyzed retrospectively. Using multivariate analysis, the correlation between clinicopathologic variables and the number of lymph nodes retrieved was evaluated. The associations between the oncologic outcome and number of lymph nodes retrieved were also investigated according to the tumor regression grade.

Results

In total, 1,332 patients were identified, of whom 433 (32.8 %) received preoperative chemoradiation. Multivariate analysis revealed that preoperative chemoradiation was an independent predictor of the number of lymph nodes retrieved (P = 0.002). After chemoradiation, the number of total and positive lymph nodes retrieved was inversely correlated with tumor regression. Retrieval of ≥12 lymph nodes was not an independent prognostic factor for disease-free survival; however, among patients with a good tumor response, those with <12 lymph nodes retrieved had a significantly better 3-year disease-free survival (P = 0.030) than those with ≥12 lymph nodes retrieved.

Conclusions

Reduced lymph node yield after preoperative chemoradiation for rectal cancer does not indicate inadequate oncologic surgery. It may represent good treatment response and better prognosis, especially in patients with good pathologic tumor regression after chemoradiation.
Appendix
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Literature
1.
Wong JH, Severino R, Honnebier MB, Tom P, Namiki TS. Number of nodes examined and staging accuracy in colorectal carcinoma. J Clin Oncol. 1999;17:2896–900.PubMed
2.
Compton CC, Fielding LP, Burgart LJ, Conley B, Cooper HS, Hamilton SR, et al. Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement, 1999. Arch Pathol Lab Med. 2000;124:979–94.PubMed
3.
Compton CC, Greene FL. The staging of colorectal cancer: 2004 and beyond. CA Cancer J Clin. 2004;54:295–308.CrossRefPubMed
4.
Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC cancer staging manual. 7th ed. New York/London: Springer; 2010.
5.
Baxter NN, Morris AM, Rothenberger DA, Tepper JE. Impact of preoperative radiation for rectal cancer on subsequent lymph node evaluation: a population-based analysis. Int J Radiat Oncol Biol Phys. 2005;61:426–31.CrossRefPubMed
6.
Govindarajan A, Gonen M, Weiser MR, Shia J, Temple LK, Guillem JG, et al. Challenging the feasibility and clinical significance of current guidelines on lymph node examination in rectal cancer in the era of neoadjuvant therapy. J Clin Oncol. 2011;29:4568–73.CrossRefPubMedCentralPubMed
7.
Ha YH, Jeong SY, Lim SB, Choi HS, Hong YS, Chang HJ, et al. Influence of preoperative chemoradiotherapy on the number of lymph nodes retrieved in rectal cancer. Ann Surg. 2010;252:336–40.CrossRefPubMed
8.
Rullier A, Laurent C, Capdepont M, Vendrely V, Belleannée G, Bioulac-Sage P, et al. Lymph nodes after preoperative chemoradiotherapy for rectal carcinoma: number, status, and impact on survival. Am J Surg Pathol. 2008;32:45–50.CrossRefPubMed
9.
Damin DC, Rosito MA, Contu PC, Tarta C, Ferreira PR, Kliemann L, et al. Lymph node retrieval after preoperative chemoradiotherapy for rectal cancer. J Gastrointest Surg. 2012;16:1573–80.CrossRefPubMed
10.
Persiani R, Biondi A, Gambacorta MA, Bertucci Zoccali M, Vecchio FM, Tufo A, et al. Prognostic implications of the lymph node count after neoadjuvant treatment for rectal cancer. Br J Surg. 2014;101:133–42.CrossRefPubMed
11.
Dworak O, Keilholz L, Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorectal Dis. 1997;12:19–23.CrossRefPubMed
12.
Park YJ, Oh BR, Lim SW, Huh JW, Joo JK, Kim YJ, et al. Clinical significance of tumor regression grade in rectal cancer with preoperative chemoradiotherapy. J Korean Soc Coloproctol. 2010;26:279–86.CrossRefPubMedCentralPubMed
13.
Huh JW, Kim YJ, Kim HR. Distribution of lymph node metastases is an independent predictor of survival for sigmoid colon and rectal cancer. Ann Surg. 2012;255:70–8.CrossRefPubMed
14.
Le Voyer TE, Sigurdson ER, Hanlon AL, Mayer RJ, Macdonald JS, Catalano PJ, et al. Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of Intergroup trial INT-0089. J Clin Oncol. 2003;21:2912–9.CrossRefPubMed
15.
Tepper JE, O’Connell MJ, Niedzwiecki D, Hollis D, Compton C, Benson AB, et al. Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol. 2001;19:157–63.PubMed
16.
Marks JH, Valsdottir EB, Rather AA, Nweze IC, Newman DA, Chernick MR. Fewer than 12 lymph nodes can be expected in a surgical specimen after high-dose chemoradiation therapy for rectal cancer. Dis Colon Rectum. 2010;53:1023–9.CrossRefPubMed
17.
Luna Perez P, Rodriguez Ramirez S, Alvarado I, Gutierrez de la Barrera M, Labastida S. Prognostic significance of retrieved lymph nodes per specimen in resected rectal adenocarcinoma after preoperative chemoradiation therapy. Arch Med Res. 2003;34:281–6.
18.
Tsai CJ, Crane CH, Skibber JM, Rodriguez‐Bigas MA, Chang GJ, Feig BW, et al. Number of lymph nodes examined and prognosis among pathologically lymph node-negative patients after preoperative chemoradiation therapy for rectal adenocarcinoma. Cancer. 2011;117:3713–22.CrossRefPubMedCentralPubMed
19.
de Campos Lobato LF, Stocchi L, de Sousa JB, Buta M, Lavery IC, Fazio VW, et al. Less than 12 nodes in the surgical specimen after total mesorectal excision following neoadjuvant chemoradiation: it means more than you think! Ann Surg Oncol. 2013;20:3398–406.
20.
Fajardo LF. Effects of ionizing radiation on lymph nodes. A review. Front Radiat Ther Oncol. 1993;28:37–45.CrossRef
21.
Fokas E, Liersch T, Fietkau R, Hohenberger W, Beissbarth T, Hess C, et al. Tumor regression grading after preoperative chemoradiotherapy for locally advanced rectal carcinoma revisited: updated results of the CAO/ARO/AIO-94 trial. J Clin Oncol. 2014;32:1554–62.CrossRefPubMed
22.
Berho M, Oviedo M, Stone E, Chen C, Nogueras J, Weiss E, et al. The correlation between tumour regression grade and lymph node status after chemoradiation in rectal cancer. Colorectal Dis. 2009;11:254–8.CrossRefPubMed
23.
Schneider PM, Baldus SE, Metzger R, Kocher M, Bongartz R, Bollschweiler E, et al. Histomorphologic tumor regression and lymph node metastases determine prognosis following neoadjuvant radiochemotherapy for esophageal cancer-implications for response classification. Ann Surg. 2005;242:684–92.CrossRefPubMedCentralPubMed
Metadata
Title
Low Lymph Node Retrieval After Preoperative Chemoradiation for Rectal Cancer is Associated with Improved Prognosis in Patients with a Good Tumor Response
Authors
Hun Jin Kim, MD
Jeong Seon Jo, MD
Soo Young Lee, MD
Chang Hyun Kim, MD
Young Jin Kim, MD, PhD
Hyeong Rok Kim, MD, PhD
Publication date
01-06-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 6/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-4235-z

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