Top

International Journal of Colorectal Disease

Published in:

01-09-2014 | Original Article

The impact of pathologic nodal status on survival following neoadjuvant chemoradiation for locally advanced rectal cancer

Authors: Jonathan M. Hernandez, Whalen Clark, Jill Weber, William J. Fulp, Lauren Lange, David Shibata

Published in: International Journal of Colorectal Disease | Issue 9/2014

Abstract

Purpose

For patients with locally advanced rectal cancer, the accuracy rates of preneoadjuvant therapy nodal staging and potential nodal downstaging make the prognostic significance of nodal status unclear. We therefore sought to review our experience in order to better understand the impact of clinical and pathologic nodal status upon patient outcomes.

Methods

174 patients were identified as having undergone neoadjuvant chemoradiation and resection for rectal cancer. For analytic purposes, patients were grouped into four nodal categories (uN⁰· pN⁰, uN⁰· pN⁺, uN ⁺ · pN⁰, and uN ⁺ · pN⁺). Univariate and multivariate analyses were performed.

Results

104 men and 70 women of median age 60 years (29–85 years) were followed for a median of 31 months (1–121 months). Nodal staging was available for 129 patients, with a median of 8 lymph nodes (range 0–39) evaluated. Disease recurred in 3 of 41 (7 %) uN ⁰·pN ⁰, 10 of 52 (20 %) uN ⁺·pN ⁰, 7 of 18 (41 %) uN ⁰·pN ⁺, and 6 of 17 (35 %) uN ⁺·pN ⁺ patients. Those patients having nodal downstaging (uN ⁺·pN ⁰) experienced superior overall survival (p = 0.03). Only pathologic nodal status was a significant predictor of both disease-free and overall survival in multivariate modeling. Adjuvant chemotherapy did not impact disease-free or overall survival for patients with pN0.

Conclusions

Pathologic nodal status may represent a superior predictor of survival for patients with local advanced rectal cancers. Our findings may have potential implications for the application of adjuvant therapy.

Fisher B, Wolmark N, Rockette H, Redmond C, Deutsch M et al (1988) Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer: results from NSABP protocol R-01. J Natl Cancer Inst 80:21–29PubMedCrossRef

(1985) Prolongation of the disease-free interval in surgically treated rectal carcinoma. Gastrointestinal Tumor Study Group. N Engl J Med 312: 1465–1472.

Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740PubMedCrossRef

Benson AB 3rd, Bekaii-Saab T, Chan E, Chen YJ, Choti MA et al (2012) Rectal cancer. J Natl Compr Canc Netw 10:1528–1564PubMed

Landmann RG, Wong WD, Hoepfl J, Shia J, Guillem JG et al (2007) Limitations of early rectal cancer nodal staging may explain failure after local excision. Dis Colon Rectum 50:1520–1525PubMedCrossRef

Kwok H, Bissett IP, Hill GL (2000) Preoperative staging of rectal cancer. Int J Colorectal Dis 15:9–20PubMedCrossRef

Kim JC, Kim HC, Yu CS, Han KR, Kim JR et al (2006) Efficacy of 3-dimensional endorectal ultrasonography compared with conventional ultrasonography and computed tomography in preoperative rectal cancer staging. Am J Surg 192:89–97PubMedCrossRef

Das P, Skibber JM, Rodriguez-Bigas MA, Feig BW, Chang GJ et al (2007) Predictors of tumor response and downstaging in patients who receive preoperative chemoradiation for rectal cancer. Cancer 109:1750–1755PubMedCrossRef

Lee JH, Kim SH, Kim JG, Cho HM, Shim BY (2011) Preoperative chemoradiotherapy (CRT) followed by laparoscopic surgery for rectal cancer: predictors of the tumor response and the long-term oncologic outcomes. Int J Radiat Oncol, Biol, Phys 81:431–438CrossRef

10.

Moureau-Zabotto L, Farnault B, de Chaisemartin C, Esterni B, Lelong B et al (2011) Predictive factors of tumor response after neoadjuvant chemoradiation for locally advanced rectal cancer. Int J Radiat Oncol, Biol, Phys 80:483–491CrossRef

11.

Casado E, Garcia VM, Sanchez JJ, Blanco M, Maurel J et al (2011) A combined strategy of SAGE and quantitative PCR provides a 13-gene signature that predicts preoperative chemoradiotherapy response and outcome in rectal cancer. Clin Cancer Res 17:4145–4154PubMedCrossRef

12.

Horisberger K, Erben P, Muessle B, Woernle C, Stroebel P et al (2009) Topoisomerase I expression correlates to response to neoadjuvant irinotecan-based chemoradiation in rectal cancer. Anticancer Drugs 20:519–524PubMedCrossRef

13.

Kobayashi H, Hashiguchi Y, Ueno H, Shinto E, Kajiwara Y et al (2007) Absence of cyclooxygenase-2 protein expression is a predictor of tumor regression in rectal cancer treated with preoperative short-term chemoradiotherapy. Dis Colon Rectum 50:1354–1362PubMedCrossRef

14.

Kudrimoti M, Lee EY, Kang Y, Ahmed M, Mohiuddin M (2007) Genetic markers predictive of response to induction chemoradiotherapy for locally advanced rectal cancers. J Ky Med Assoc 105:18–22PubMed

15.

Kuremsky JG, Tepper JE, McLeod HL (2009) Biomarkers for response to neoadjuvant chemoradiation for rectal cancer. Int J Radiat Oncol, Biol, Phys 74:673–688CrossRef

16.

Lin LC, Lee HH, Hwang WS, Li CF, Huang CT et al (2006) p53 and p27 as predictors of clinical outcome for rectal-cancer patients receiving neoadjuvant therapy. Surg Oncol 15:211–216PubMedCrossRef

17.

Pucciarelli S, Rampazzo E, Briarava M, Maretto I, Agostini M et al (2012) Telomere-specific reverse transcriptase (hTERT) and cell-free RNA in plasma as predictors of pathologic tumor response in rectal cancer patients receiving neoadjuvant chemoradiotherapy. Ann Surg Oncol 19:3089–3096PubMedCrossRef

18.

Saigusa S, Toiyama Y, Tanaka K, Okugawa Y, Fujikawa H et al (2012) Prognostic significance of glucose transporter-1 (GLUT1) gene expression in rectal cancer after preoperative chemoradiotherapy. Surg Today 42:460–469PubMedCrossRef

19.

Maretto I, Pomerri F, Pucciarelli S, Mescoli C, Belluco E et al (2007) The potential of restaging in the prediction of pathologic response after preoperative chemoradiotherapy for rectal cancer. Ann Surg Oncol 14:455–461PubMedCrossRef

20.

Pomerri F, Pucciarelli S, Maretto I, Zandona M, Del Bianco P et al (2011) Prospective assessment of imaging after preoperative chemoradiotherapy for rectal cancer. Surgery 149:56–64PubMedCrossRef

21.

Abdul-Jalil KI, Sheehan KM, Kehoe J, Cummins R, O'Grady A, et al. (2013) The prognostic value of tumour regression grade following neoadjuvant chemoradiation therapy for rectal cancer. Colorectal Dis

22.

Arredondo J, Baixauli J, Beorlegui C, Arbea L, Rodriguez J et al (2013) Prognosis factors for recurrence in patients with locally advanced rectal cancer preoperatively treated with chemoradiotherapy and adjuvant chemotherapy. Dis Colon Rectum 56:416–421PubMedCrossRef

23.

Elezkurtaj S, Moser L, Budczies J, Muller AJ, Blaker H et al (2013) Histopathological regression grading matches excellently with local and regional spread after neoadjuvant therapy of rectal cancer. Pathol Res Pract 209:424–428PubMedCrossRef

24.

Dhadda AS, Bessell EM, Scholefield J, Dickinson P, Zaitoun AM (2014) Mandard tumour regression grade, perineural invasion, circumferential resection margin and post-chemoradiation nodal status strongly predict outcome in locally advanced rectal cancer treated with preoperative chemoradiotherapy. Clin Oncol (R Coll Radiol) 26:197–202CrossRef

25.

Damin DC, Rosito MA, Contu PC, Tarta C, Ferreira PR et al (2012) Lymph node retrieval after preoperative chemoradiotherapy for rectal cancer. J Gastrointest Surg 16:1573–1580PubMedCrossRef

26.

Tsai CJ, Crane CH, Skibber JM, Rodriguez-Bigas MA, Chang GJ et al (2011) Number of lymph nodes examined and prognosis among pathologically lymph node-negative patients after preoperative chemoradiation therapy for rectal adenocarcinoma. Cancer 117:3713–3722PubMedCentralPubMedCrossRef

27.

de Campos-Lobato LF, Stocchi L, de Sousa JB, Buta M, Lavery IC et al (2013) Less than 12 nodes in the surgical specimen after total mesorectal excision following neoadjuvant chemoradiation: it means more than you think! Ann Surg Oncol 20:3398–3406PubMedCrossRef

28.

Sprenger T, Rothe H, Becker H, Beissbarth T, Homayounfar K et al (2013) Lymph node metastases in rectal cancer after preoperative radiochemotherapy: impact of intramesorectal distribution and residual micrometastatic involvement. Am J Surg Pathol 37:1283–1289PubMedCrossRef

29.

Bosset JF, Collette L, Calais G, Mineur L, Maingon P et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355:1114–1123PubMedCrossRef

Title: The impact of pathologic nodal status on survival following neoadjuvant chemoradiation for locally advanced rectal cancer
Authors: Jonathan M. Hernandez
Whalen Clark
Jill Weber
William J. Fulp
Lauren Lange
David Shibata
Publication date: 01-09-2014
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 9/2014
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-014-1917-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The impact of pathologic nodal status on survival following neoadjuvant chemoradiation for locally advanced rectal cancer

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2014

Totally laparoscopic resection with natural orifice specimen extraction (NOSE) has more advantages comparing with laparoscopic-assisted resection for selected patients with sigmoid colon or rectal cancer

Incidence and prognosis of lower rectal cancer with limited extramesorectal lymph node metastasis

A temporary loop ileostomy affects renal function

Impact of the perioperative neutrophil-to-lymphocyte ratio on the long-term survival following an elective resection of colorectal carcinoma

Short-term outcome of laparoscopic versus robotic ventral mesh rectopexy for full-thickness rectal prolapse. Is robotic superior?

Adenocarcinoma on j-pouch after proctocolectomy for ulcerative colitis—case report and review of literature