An Overview of Five-Year Survival in Rectal Cancer in Relation to Lymph Node Status

Benedek, Zalán; Boér, Szabolcs Todor; Bauer, Orsolya; Sárdi, Kálmán; Todor, Attila; Suciu, Nicolae; Coroș, Marius Florin

doi:10.21614/chirurgia.115.6.747

Cited by 6 publications

(12 citation statements)

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“…6,7 A series of studies have suggested the improved prognosis of rectal cancer after surgery, even in patients with stage IV, including the increased overall survival rate, decreased distant recurrence rate, and prevention of complications. 5,8,9 However, due to the relatively lower sample size incorporated into the studies, results were not so consistent. 10,11 Moreover, due to the heterogeneity distribution of the clinical characteristics, furthermore, certain patient subgroups, such as those with advanced age or multiple organ metastases, may not benefit from surgery.…”

Section: Introductionmentioning

confidence: 88%

“…The 5-year survival may decrease to about 20% when rectal cancer progresses to distant metastasis. [3][4][5] Surgery is acknowledged as the cornerstone of rectal cancer treatment. 6,7 A series of studies have suggested the improved prognosis of rectal cancer after surgery, even in patients with stage IV, including the increased overall survival rate, decreased distant recurrence rate, and prevention of complications.…”

Section: Introductionmentioning

confidence: 99%

“…2 The 5-year survival may decrease to about 20% when rectal cancer progresses to distant metastasis. 3 – 5 …”

Section: Introductionmentioning

confidence: 99%

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Not all Rectal Cancer Patients Could Benefit From the Surgery on the Primary Site

Zhou

Xia

et al. 2023

Cancer Control

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Aim Previous studies have provided evidence that primary site surgery can improve the prognosis of rectal cancer patients, even in those with advanced age and distant metastasis, though results have been inconsistent. The current study aims to determine if all rectal cancer patients are likely to benefit from surgery in terms of overall survival. Methods This study examined the impact of primary site surgery on the prognosis of rectal cancer patients diagnosed between 2010 and 2019 using multivariable Cox regression analysis. The study also stratified patients by age group, M stage, chemotherapy, radiotherapy, and number of distant metastatic organs. The propensity score matching method was used to balance observed covariates between patients who received and did not receive surgery. The Kaplan–Meier method was used to analyze the data, and the log-rank test was used to determine differences between patients who did and did not undergo surgery. Results The study included 76,941 rectal cancer patients, with a median survival of 81.0 months (95% CI: 79.2–82.8 months). Of these patients, 52,360 (68.1%) received primary site surgery, and they tended to be younger, have higher differentiated grade, earlier T, N, M stage, and lower rates of bone, brain, lung, and liver metastasis, chemotherapy, and radiotherapy than those without surgery. Multivariable Cox regression analysis revealed that surgery had a protective effect on the prognosis of rectal cancer patients, including those with advanced age, distant metastasis, and multiple organ metastasis, but not in patients with four organ metastases. The results were also confirmed using propensity score matching. Conclusion Not all rectal cancer patients could benefit from the surgery on the primary site, especially the patients with more than four distant metastases. The results could help the clinicians to tailor targeted treatment regimens and provide a guideline for making surgical decisions.

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Section: Introductionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

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Not all Rectal Cancer Patients Could Benefit From the Surgery on the Primary Site

Zhou

Xia

et al. 2023

Cancer Control

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“…Rectal cancer account for about 30% of newly diagnosed colorectal cancer patients and the 5year survival rate was calculated to be 67% [2]. The 5-year survival may decrease to about 20% when rectal cancer progresses to distant metastasis [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…Surgery is acknowledged as the cornerstone of rectal cancer treatment [6,7]. A series of studies have suggested the improved prognosis of rectal cancer after surgery, even in patients with stage IV, including the increased overall survival rate, decreased distant recurrence rate, and prevention of complications [5,8,9]. However, due to the relatively lower sample size incorporated into the studies, results were not so consistent [10,11].…”

Section: Introductionmentioning

confidence: 99%

Not all rectal cancer patients could benefit from the surgery on the primary site

Zhou

Xia

et al. 2022

Preprint

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Purpose Pieces of evidence showed the surgery on the primary site could improve the prognosis of rectal cancer patients, but the results were inconsistent. The present study investigates whether all patients could benefit from the surgery. Methods The rectal cancer patients diagnosed between 2010 and 2019 in the Surveillance, Epidemiology, and End Results cohort were included. Multivariable Cox regression was utilized to investigate the effect of the primary site surgery on the prognosis in total patients and stratified by the age, M stage and the number of distant metastatic organs. The propensity score matching (PSM) method was also used to balance observed covariates and Kaplan-Meier method with the log-rank test was used to exam the differences in the prognosis. Results A total of 76,941 rectal cancer patients were included and about 68.1% received surgery. The patients with surgery have a relatively lower proportion of advanced age, higher differentiated grade, T stage, N stage, M stage, and bone, brain, lung, and liver metastasis than patients without surgery. Multivariable Cox regression showed a protective effect of the surgery on the prognosis, even in patients with advanced age, distant metastasis, and multiple organ metastasis. However, no association was found in patients with four organ metastases. The PSM also confirmed the results mentioned above. Conclusion Not all rectal cancer patients could benefit from the surgery, especially the patients with four organ distant metastases. The results could help the clinicians to tailor targeted treatment regimens and provide a guideline for making surgical decisions.

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Influence of Neoadjuvant Therapy on the Ratio of Lymph Nodes

CREDIDIO,

MARTINEZ,

MAGRO

et al. 2024

Arq. Gastroenterol.

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Background: To evaluate the relationship between the ratio of affected lymph nodes (LNR) and clinical and anatomopathological variables in patients with rectal adenocarcinoma submitted or not to neoadjuvant chemoradiotherapy. Methods: The LNR was determined by dividing the number of compromised LNR by the total number of LNR dissected in the surgical specimen. Patients were divided into two groups: with QRT and without QRT. In each group, the relationship between LNR and the following variables was evaluated: degree of cell differentiation, depth of invasion in the rectal wall, angiolymphatic /perineural invasion, degree of tumor regression and occurrence of metastases. The LNR was evaluated in patients with more than 1, LNR (LNR >12) or less (LNR<12) in the surgical specimen with overall survival (OS) and disease-free survival (DFS). The results were expressed as the mean with the respective standard deviation. Qualitative variables were analyzed using Fisher’s exact test, while quantitative variables were analyzed using the Kruskal -Wallis and Mann-Whitney tests. The significance level was 5%. Results: We evaluated 282 patients with QRT and 114 without QRT, between 1995-2011. In the QRT Group, LNR showed a significant association with mucinous tumors (P=0.007) and degree of tumor regression (P=0.003). In both groups, LNR was associated with poorly differentiated tumors (P=0.001, P=0.02), presence of angiolymphatic invasion (P<0.0001 and P=0.01), perineural (P=0.0007, P=0.02), degree of rectal wall invasion (T3>T2; P<0.0001, P=0.02); Compromised LNR (P<0.0001, P<0.01), metastases (P<0.0001, P<0.01). In patients with QRT, LNR<12 was associated with DFS (5.889; 95%CI1.935-19.687; P=0.018) and LNR>12 with DFS and OS (17.984; 95%CI5.931-54.351; P<0.001 and 10.286; 95%CI 2.654-39.854; P=0.007, respectively). Conclusion: LNR was associated with histological aspects of poor prognosis, regardless of the use of QRT. In the occurrence of less than 12 evaluated LNR, the LNR was associated only with the DFS.

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An Overview of Five-Year Survival in Rectal Cancer in Relation to Lymph Node Status

Cited by 6 publications

References 0 publications

Not all Rectal Cancer Patients Could Benefit From the Surgery on the Primary Site

Not all Rectal Cancer Patients Could Benefit From the Surgery on the Primary Site

Not all rectal cancer patients could benefit from the surgery on the primary site

Influence of Neoadjuvant Therapy on the Ratio of Lymph Nodes

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