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World Journal of Surgical Oncology

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Open Access 01-12-2020 | Rectal Cancer | Research

A lower cut-off for lymph node harvest predicts for poorer overall survival after rectal surgery post neoadjuvant chemoradiotherapy

Authors: Charleen Shanwen Yeo, Nicholas Syn, Huimin Liu, Sau Shung Fong

Published in: World Journal of Surgical Oncology | Issue 1/2020

Abstract

Background

A lymph node harvest (LNH) of < 12 is a predictor for poor prognosis in rectal cancer patients. However, neoadjuvant chemoradiotherapy (NACRT) is known to decrease LNH; hence, a cut-off of 12 is inappropriate in such patients. This paper aims to establish a LNH cut-off predictive for disease-free and overall survival in NACRT patients.

Methods

A retrospective review of patients who underwent elective surgery for rectal cancer from 2006 to 2013 was performed. All patients with R1/2 resections and presence of metastases and those operated on for recurrence were excluded. Patient demographics, clinical features, operative details, LNH, 30-day mortality and disease-free and overall survival were recorded. P values of < 0.05 were considered significant.

Results

A total of 257 patients were studied, with 174 (68%) males and a median age of 66 years. Ninety-four (37%) patients received long-course NACRT, and 122 (48%) patients were stage 2 and below. Median LNH was 17, which was reduced in the NACRT group (14 versus 23, P < 0.01). Average length of stay was 9 ± 8 days, with a major post-operative complication rate of 4%. Using hazard ratio plots for the NACRT subgroup, LNH cut-offs of 16.5 and 8.5 were obtained for disease-free survival (DFS) and overall survival (OS) respectively. Survival analysis showed that a LNH cut-off of 8.5 was a significant predictor of OS (P < 0.001).

Conclusion

LNH is reduced in patients receiving NACRT before rectal cancer surgery. A LNH of 9 and above is associated with improved overall survival. We propose that this can be used as a tool for prognosis.

Compton CC, Fielding LP, Burgart LJ, Conley B, Cooper HS, Hamilton SR, Hammond ME, Henson DE, Hutter RV, Nagle RB, Nielsen ML, Sargent DJ, Taylor CR, Welton M, Willett C. Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999. Archives of pathology & laboratory medicine. 2000;124(7):979–94. https://doi.org/10.1043/0003-9985(2000)124<0979:Pficc>2.0.Co;2.CrossRef

Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Annals of surgical oncology. 2010;17(6):1471–4. https://doi.org/10.1245/s10434-010-0985-4.CrossRefPubMed

Miller ED, Robb BW, Cummings OW, Johnstone PA. The effects of preoperative chemoradiotherapy on lymph node sampling in rectal cancer. Diseases of the colon and rectum. 2012;55(9):1002–7. https://doi.org/10.1097/DCR.0b013e3182536d70.CrossRefPubMed

Ha YH, Jeong SY, Lim SB, Choi HS, Hong YS, Chang HJ, Kim DY, Jung KH, Park JG. Influence of preoperative chemoradiotherapy on the number of lymph nodes retrieved in rectal cancer. Annals of surgery. 2010;252(2):336–40. https://doi.org/10.1097/SLA.0b013e3181e61e33.CrossRefPubMed

Amajoyi R, Lee Y, Recio PJ, Kondylis PD (2013) Neoadjuvant therapy for rectal cancer decreases the number of lymph nodes harvested in operative specimens. Am J Surg 205 (3):289-292; discussion 292. doi:https://doi.org/10.1016/j.amjsurg.2012.10.020.CrossRef

Gunderson LL, Jessup JM, Sargent DJ, Greene FL, Stewart A. Revised tumor and node categorization for rectal cancer based on surveillance, epidemiology, and end results and rectal pooled analysis outcomes. J Clin Oncol. 2010;28(2):256–63. https://doi.org/10.1200/jco.2009.23.9194.CrossRefPubMed

Kim YW, Kim NK, Min BS, Lee KY, Sohn SK, Cho CH. The influence of the number of retrieved lymph nodes on staging and survival in patients with stage II and III rectal cancer undergoing tumor-specific mesorectal excision. Ann Surg. 2009;249(6):965–72. https://doi.org/10.1097/SLA.0b013e3181a6cc25.CrossRefPubMed

Gill A, Brunson A, Lara P Jr, Khatri V, Semrad TJ. Implications of lymph node retrieval in locoregional rectal cancer treated with chemoradiotherapy: a California Cancer Registry Study. Eur J Surg Oncol. 2015;41(5):647–52. https://doi.org/10.1016/j.ejso.2015.01.037.CrossRefPubMedPubMedCentral

Kim HJ, Jo JS, Lee SY, Kim CH, Kim YJ, Kim HR. Low lymph node retrieval after preoperative chemoradiation for rectal cancer is associated with improved prognosis in patients with a good tumor response. Ann Surg Oncol. 2015;22(6):2075–81. https://doi.org/10.1245/s10434-014-4235-z.CrossRefPubMed

10.

Tsai CJ, Crane CH, Skibber JM, Rodriguez-Bigas MA, Chang GJ, Feig BW, Eng C, Krishnan S, Maru DM, Das P. Number of lymph nodes examined and prognosis among pathologically lymph node-negative patients after preoperative chemoradiation therapy for rectal adenocarcinoma. Cancer. 2011;117(16):3713–22. https://doi.org/10.1002/cncr.25973.CrossRefPubMedPubMedCentral

11.

Xu Z, Berho ME, Becerra AZ, Aquina CT, Hensley BJ, Arsalanizadeh R, Noyes K, Monson JRT, Fleming FJ. Lymph node yield is an independent predictor of survival in rectal cancer regardless of receipt of neoadjuvant therapy. J Clin Pathol. 2017;70(7):584–92. https://doi.org/10.1136/jclinpath-2016-203995.CrossRefPubMed

12.

Persiani R, Biondi A, Gambacorta MA, Bertucci Zoccali M, Vecchio FM, Tufo A, Coco C, Valentini V, Doglietto GB, D’Ugo D. Prognostic implications of the lymph node count after neoadjuvant treatment for rectal cancer. Br J Surg. 2014;101(2):133–42. https://doi.org/10.1002/bjs.9341.CrossRefPubMed

13.

Lykke J, Jess P, Roikjaer O. Increased lymph node yield is associated with improved survival in rectal cancer irrespective of neoadjuvant treatment: results from a national cohort study. Dis Colon Rectum. 2015;58(9):823–30. https://doi.org/10.1097/dcr.0000000000000429.CrossRefPubMed

14.

Mechera R, Schuster T, Rosenberg R, Speich B. Lymph node yield after rectal resection in patients treated with neoadjuvant radiation for rectal cancer: a systematic review and meta-analysis. Eur J Cancer. 2017;72:84–94. https://doi.org/10.1016/j.ejca.2016.10.031.CrossRefPubMed

15.

Scott N, Thorne C, Jayne D. Lymph node retrieval after neoadjuvant radiotherapy for rectal adenocarcinoma. J Clin Pathol. 2004;57(3):335–6. https://doi.org/10.1136/jcp.2003.013441.CrossRefPubMedPubMedCentral

16.

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(2):426–31. https://doi.org/10.1016/j.ijrobp.2004.06.259.CrossRefPubMed

17.

Abdel-Misih SR, Wei L, Benson AB 3rd, Cohen S, Lai L, Skibber J, Wilkinson N, Weiser M, Schrag D, Bekaii-Saab T. Neoadjuvant therapy for rectal cancer affects lymph node yield and status without clear implications on outcome: the case for eliminating a metric and using preoperative staging to guide therapy. J Natl Compr Canc Netw. 2016;14(12):1528–34.CrossRef

18.

Rullier A, Laurent C, Capdepont M, Vendrely V, Belleannee G, Bioulac-Sage P, Rullier E. Lymph nodes after preoperative chemoradiotherapy for rectal carcinoma: number, status, and impact on survival. Am J Surg Pathol. 2008;32(1):45–50. https://doi.org/10.1097/PAS.0b013e3180dc92ab.CrossRefPubMed

19.

Greenlee RT, Hill-Harmon MB, Murray T, Thun M. Cancer statistics, 2001. CA Cancer J Clin. 2001;51(1):15–36. https://doi.org/10.3322/canjclin.51.1.15.CrossRefPubMed

20.

Krzyzanowska MK, Regan MM, Powell M, Earle CC, Weeks JC. Impact of patient age and comorbidity on surgeon versus oncologist preferences for adjuvant chemotherapy for stage III colon cancer. J Am Coll Surg. 2009;208(2):202–9. https://doi.org/10.1016/j.jamcollsurg.2008.10.016.CrossRefPubMed

21.

Biondi A, Vacante M, Ambrosino I, Cristaldi E, Pietrapertosa G, Basile F. Role of surgery for colorectal cancer in the elderly. World journal of gastrointestinal surgery. 2016;8(9):606–13. https://doi.org/10.4240/wjgs.v8.i9.606.CrossRefPubMedPubMedCentral

22.

Chan DKH, Tan KK. Lower lymph node yield following neoadjuvant therapy for rectal cancer has no clinical significance. Journal of gastrointestinal oncology. 2019;10(1):42–7. https://doi.org/10.21037/jgo.2018.10.02.CrossRefPubMedPubMedCentral

Title: A lower cut-off for lymph node harvest predicts for poorer overall survival after rectal surgery post neoadjuvant chemoradiotherapy
Authors: Charleen Shanwen Yeo
Nicholas Syn
Huimin Liu
Sau Shung Fong
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Rectal Cancer
Rectal Cancer
Cytostatic Therapy
Published in: World Journal of Surgical Oncology / Issue 1/2020
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/s12957-020-01833-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A lower cut-off for lymph node harvest predicts for poorer overall survival after rectal surgery post neoadjuvant chemoradiotherapy

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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