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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2015

01-12-2015 | Colorectal Cancer

Impact of Total Lymph Node Count on Staging and Survival After Neoadjuvant Chemoradiation Therapy for Rectal Cancer

Authors: Matthew D. Hall, MD, MBA, Timothy E. Schultheiss, PhD, David D. Smith, PhD, Marwan G. Fakih, MD, Joseph Kim, MD, Jeffrey Y. C. Wong, MD, Yi-Jen Chen, MD, PhD

Published in: Annals of Surgical Oncology | Special Issue 3/2015

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Abstract

Purpose

Current guidelines recommend that a minimum of 12 lymph nodes (LNs) be dissected to accurately stage rectal cancer patients. Neoadjuvant chemoradiation therapy (CRT) decreases the number of LNs retrieved at surgery. The purpose of this study was to assess the impact of the number of LNs dissected on overall survival (OS) for localized rectal cancer patients treated with neoadjuvant CRT.

Methods

Treatment data were obtained on all patients treated for rectal cancer (2000–2013) in the National Oncology Data Alliance™, a proprietary database of merged tumor registries. Eligible patients were treated with neoadjuvant CRT followed by surgery and had complete data on number of positive LNs, number of LNs examined, and treatment dates (n = 4565).

Results

Hazard ratios for OS decreased sequentially with increasing number of LNs examined until a maximum benefit was achieved with examination of eight LNs. On multivariate analysis, age, sex, race, marital status, grade, ypT stage, ypN stage, type of surgery, margin status, presence of pathologically confirmed metastasis at surgery, and number of LNs examined were significant predictors of OS.

Conclusions

Examination of eight or more LNs in rectal cancer patients treated with neoadjuvant CRT resulted in accurate staging and assignment into prognostic groups with an ensuing improvement in OS by stage. This study suggests that eight LNs is the threshold for an adequate lymph node dissection after neoadjuvant CRT.
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Metadata
Title
Impact of Total Lymph Node Count on Staging and Survival After Neoadjuvant Chemoradiation Therapy for Rectal Cancer
Authors
Matthew D. Hall, MD, MBA
Timothy E. Schultheiss, PhD
David D. Smith, PhD
Marwan G. Fakih, MD
Joseph Kim, MD
Jeffrey Y. C. Wong, MD
Yi-Jen Chen, MD, PhD
Publication date
01-12-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue Special Issue 3/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4585-1

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