Effects of neoadjuvant chemotherapy plus chemoradiotherapy on lymph nodes in rectal adenocarcinoma

Chotard, Guillaume; Capdepont, Maylis; Denost, Quentin; Smith, Denis; Vendrely, V.; Rullier, Anne

doi:10.1007/s00428-021-03108-3

Cited by 7 publications

(13 citation statements)

References 39 publications

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“…Although eight articles in the systematic review showed that BMI was not associated with the number of retrieved LNs,20 22 23 28 31 35 55 64 the other two articles revealed that high BMI was associated with fewer retrieved LNs (online supplemental table 6). 26 30 Furthermore, the meta-analysis including 7 studies with 34 351 patients revealed no significant differences in the overweight and obesity groups compared with the normal-weight group in colorectal cancer (OR=0.93, 95% CI (0.87 to 1.00), p=0.054, I 2 =0.00%) (figure 2 and online supplemental figure 4).…”

Section: Resultsmentioning

confidence: 99%

“…From these articles, 90 articles were excluded because the papers were not in English or Chinese (n=2), had unavailable data (n=23) and were unrelated (n=65). Finally, 54 studies were included, with 30 included in the systematic review,5 19–47 and 24 in the meta-analysis (figure 1). 12–14 48–68…”

Section: Resultsmentioning

confidence: 99%

“…In the systematic review, 20 articles revealed no significant association between age and the retrieval of LNs in colorectal cancer 21–23 26 27 30 32 35 37–41 47–49 54 55 64 65. However, 18 articles indicated that more LNs were obtained from young patients than elderly patients (online supplemental table 6).…”

Section: Resultsmentioning

confidence: 99%

“…The analysis of gender and retrieved LNs in colorectal cancer using systematic review included ten colorectal cancer,21 26 27 31 32 36 37 39 41 51 five colon cancer22 30 35 44 47 and five rectal cancer studies 23 38 42 54 65. These studies showed that gender had no significant association with the LN yield.…”

Section: Resultsmentioning

confidence: 99%

“…As per the location of the tumour in the rectum, although three studies suggested that more LNs could be obtained from the upper rectum than the lower rectum,31 62 68 three studies found no significant association between rectal location and LN yield (online supplemental table 6). 23 38 42 The meta-analysis of eight studies containing 47 706 patients with colon cancer showed that fewer LNs were obtained from tumours located in the left colon than in the right colon (OR=0.43, 95% CI (0.33 to 0.56), p<0.001, I 2 =88.27%) (figure 3 and online supplemental figure 7). 12–14 49 56 58 60 66 Likewise, the same eight studies that included 52 893 patients with colorectal cancer showed that fewer LNs were obtained from tumours located in other locations than in the right colon (OR=0.51, 95% CI (0.45 to 0.57, p<0.001, I 2 =38.47%) (figure 2 and online supplemental figure 8).…”

Section: Resultsmentioning

confidence: 99%

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Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis

Liu,

Huang,

Yang

et al. 2023

BMJ Open

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ObjectiveClinical practice guidelines recommend retrieving at least 12 lymph nodes for correct staging in colorectal cancer. However, it is difficult to retrieve adequate lymph nodes because of various factors. We aimed to evaluate the association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer.DesignSystematic review and meta-analysis of primary studies.Data sourcesPubMed, Embase, Cochrane and Web of Science were searched from January 2016 to June 2023.Eligibility criteria for selecting studiesStudies that evaluated the association between retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer were included.Data extraction and synthesisOR with 95% conference intervals was extracted and pooled.ResultsA total of 54 studies containing 2 05 821 patients were included in this meta-analysis. The results showed that fewer nodes were retrieved from elderly patients (OR=0.70, 95% CI (0.54 to 0.90), p=0.005), and from tumours located in the left colon than in the right colon (OR=0.43, 95% CI (0.33 to 0.56), p<0.001). More lymph nodes were obtained from females than males (OR=1.15, 95% CI (1.04 to 1.28), p=0.006), from the advanced T stage (T3+T4) than T1+T2 stage (OR=1.57, 95% CI (1.25 to 1.97), p<0.001) and from the N2 stage than N0 stage (OR=1.32, 95% CI (1.15 to 1.51), p<0.001). Body mass index, ethnicity, N1 stage, M stage, tumour differentiation and lymph–vascular invasion were not significantly associated with the lymph node yield.ConclusionsThe study results suggest that clinicians have an increased opportunity to retrieve sufficient lymph nodes for accurate pathological staging to guide treatment decisions in patients with colorectal cancer who are young, female, with tumours located in the right colon, advanced T stage and N2 stage.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis

Liu,

Huang,

Yang

et al. 2023

BMJ Open

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Total neoadjuvant therapy for locally advanced rectal cancer: a three-group propensity score matched study

Zhou,

Huang,

Zhou

et al. 2024

Int J Colorectal Dis

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Purpose Total neoadjuvant therapy (TNT) has emerged as a therapeutic approach for locally advanced rectal cancer (LARC). However, the optimal chemotherapy cycles within TNT remain uncertain. This study aimed to evaluate and compare the prognostic efficacy of varying cycles of chemotherapy during TNT for LARC. Methods Patients diagnosed with LARC (T3-4N0M0/T1-4N1-2M0), who underwent TNT or chemoradiotherapy followed by total mesorectal excision (TME) between 2015 and 2020, were retrospective included. Patients were categorized into three groups based on their neoadjuvant strategy: CRT (long-course chemoradiotherapy), STNT (long-course CRT with one to three cycles of chemotherapy), and LTNT (long-course CRT with four or more cycles of chemotherapy). Propensity score matching (PSM) based on gender, age, body mass index, tumor distance from the anal verge, clinical T stage, clinical N stage, and mesorectal fascia status was employed to reduce confounding bias. Primary endpoints were disease-free survival (DFS) and metastasis-free survival (MFS). Results The study comprised 372 patients, with 73 patients in each group after PSM. Compared with CRT, both STNT and LTNT demonstrated improved DFS (5-year rate: 59.7% vs. 77.8% vs. 76.5%, p = 0.027) and MFS (5-year rate: 65.1% vs. 81.3% vs. 81.4%, p = 0.030). There was no difference in DFS or MFS between STNT and LTNT. These favorable outcomes were consistent among subgroups defined by tumor distance from the anal verge ≥ 5 cm, clinical T3 stage, clinical N positive status, or involved mesorectal fascia. Conclusion Compared to CRT, both STNT and LTNT demonstrated improved DFS and MFS outcomes. Notably, survival outcomes were similar between STNT and LTNT, suggesting that chemotherapy cycles in TNT may not significantly impact survival.

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Impact of lymph node retrieval on prognosis in elderly and non-elderly patients with T3-4/N+ rectal cancer following neoadjuvant therapy: a retrospective cohort study

Liang,

Xie,

et al. 2024

Int J Colorectal Dis

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Purpose The optimal number of lymph nodes to be resected in patients with rectal cancer who undergo radical surgery after neoadjuvant therapy remains controversial. This study evaluated the prognostic variances between elderly and non-elderly patients and determined the ideal number of lymph nodes to be removed in these patients. Methods The Surveillance, Epidemiology, and End Results (SEER) datasets were used to gather information on 7894 patients diagnosed with stage T3-4/N+ rectal cancer who underwent neoadjuvant therapy from 2010 to 2019. Of these patients, 2787 were elderly and 5107 were non-elderly. A total of 152 patients from the Longyan First Affiliated Hospital of Fujian Medical University were used for external validation. Overall survival (OS) and cancer-specific survival (CSS) were evaluated to determine the optimal quantity of lymph nodes for surgical resection. Results The study found significant differences in OS and CSS between elderly and non-elderly patients, both before and after adjustment for confounders (P < 0.001). The removal of 14 lymph nodes may be considered a benchmark for patients with stage T3-4/N+ rectal cancer who undergo radical surgery following neoadjuvant therapy, as this number provides a more accurate foundation for the personalized treatment of rectal cancer. External data validated the differences in OS and CSS and supported the 14 lymph nodes as a new benchmark in these patients. Conclusion For patients with T3-4/N+ stage rectal cancer who undergo radical surgery following neoadjuvant therapy, the removal of 14 lymph nodes serves as a cutoff point that distinctly separates patients with a favorable prognosis from those with an unfavorable one.

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Effects of neoadjuvant chemotherapy plus chemoradiotherapy on lymph nodes in rectal adenocarcinoma

Cited by 7 publications

References 39 publications

Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis

Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis

Total neoadjuvant therapy for locally advanced rectal cancer: a three-group propensity score matched study

Impact of lymph node retrieval on prognosis in elderly and non-elderly patients with T3-4/N+ rectal cancer following neoadjuvant therapy: a retrospective cohort study

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