Increased lymph node yield indicates improved survival in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy

Abstract

Purpose It is recommended for colorectal cancer to harvest at least 12 lymph nodes (LNs) during surgery to avoid understaging of the disease. However, it is still controversial whether it is necessary to harvest from locally advanced rectal cancer (LARC) patients who underwent neoadjuvant chemoradiotherapy (neo‐CRT). The impact of lymph node yield (LNY) on prognosis in LARC patients was analyzed. Materials/Methods In total, 495 LARC patients who underwent neo‐CRT in 2006‐2015 were analyzed. After examining clinicopathological distribution differences between the LNY subgroups (with the threshold of 12), univariate and multivariate Cox survival analyses were performed. Survival plots were obtained from Kaplan‐Meier analyses. Similar subgroup analyses were performed according to the tumor regression grade (TRG) and metastatic status of post‐operational LNs. Results Of the 495 patients, 287 (57.98%) had an LNY of less than 12. Nearly no significant clinicopathological difference was found between the LNY subgroups, including the TRG scores. Multivariate survival analysis demonstrated that at least 12 LNs examined was an independent prognostic feature of good overall survival (OS), disease‐free survival (DFS), and distant metastasis free survival (DMFS), but not local recurrence free survival (LRFS). However, in the subgroup analyses, no association was found between LNY and prognosis in patients with good TRG scores (0‐1) or negative LNs. Conclusions For LARC patients treated with neo‐CRT, an LNY of at least 12 indicated an improved survival. Decreased LNY was not related to better tumor regression. It suggests that a sufficiently high LNY is still required, especially in those with a potentially poor tumor response.

Influence of Tumor Location on Short- and Long-Term Outcomes After Laparoscopic Surgery for Rectal Cancer: A Propensity Score Matched Cohort Study

“…In our multivariate analysis, the number of harvested lymph nodes was one of the independent predictors of PFS. This finding was consistent with previous studies by Xu et al [28] and Wang et al [29].…”

Influence of Tumor Location on Short- and Long-Term Outcomes After Laparoscopic Surgery for Rectal Cancer: A Propensity Score Matched Cohort Study

“…In our multivariate analysis, the number of harvested lymph nodes was one of the independent predictors of PFS. This nding was consistent with previous studies by Xu et al [28] and Wang et al [29].…”

Influence of tumor location on short- and long-term outcomes after laparoscopic surgery for rectal cancer: a propensity score matched cohort study

“…Moreover, some of the findings also noted that retrieval of less than 12 lymph nodes in the proctectomy specimen of rectal cancer treated with NAT had no adverse effect on long-term survival and may be a marker of higher tumor response [26][27][28][29]. On the contrary, other studies indicated that lymph node yield was an independent predictor of survival in rectal cancer irrespective of NAT [30,31]. In our matched cohort, propensity score matching basically eliminated the difference in NAT between LRC and M/HRC patients.…”