Lymph node yield is an independent predictor of survival in rectal cancer regardless of receipt of neoadjuvant therapy

Xu, Zhaomin; Berho, Mariana; Becerra, Adan Z.; Aquina, Christopher T.; Hensley, Bradley J.; Arsalani‐Zadeh, Reza; Noyes, Katia; Monson, J. R. T.; Fleming, Fergal J.

doi:10.1136/jclinpath-2016-203995

Cited by 37 publications

(39 citation statements)

References 33 publications

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“…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].…”

Section: Discussionsupporting

confidence: 94%

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

Yang

Yao

Cui

et al. 2020

Preprint

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Background: This study aimed to evaluate the short- and long-term outcomes after laparoscopic resection for low rectal cancer (LRC) compared with mid/high rectal cancer (M/HRC). Methods: Patients with rectal cancer undergoing laparoscopic resection with curative intent were retrospectively reviewed between 2009 and 2015. After matched 1:1 by using propensity score analysis, perioperative and oncological outcomes were compared between LRC and M/HRC groups. Multivariate analysis was performed to identify independent factors of overall survival (OS) and disease-free survival (DFS). Results: Of 373 patients who met the criteria for inclusion, 260 patients were matched for the analysis. Laparoscopic surgery for LRC required longer operative time (P＜0.001) and more blood loss volume (P＜0.001) compared with M/HRC, and the LRC group tended to have a higher incidence of postoperative complications (18.5% vs. 10.0%, P=0.051). There was no significant difference in local recurrence between the two groups (6.2% vs. 2.3%, P=0.216), whereas distant metastasis was more frequent in LRC patients compared with M/HRC (19.2% vs. 9.2%, P=0.021). The LRC group showed significantly inferior 5-year OS (78.1% vs. 88.8%, P=0.008) and DFS (76.2% vs. 89.0%, P=0.004) compared with the M/HRC group. Multivariate analysis indicated that tumor location was an independent predictor of OS (HR=2.095, 95% CI 1.142-3.843, P=0.017) and DFS (HR=2.320, 95% CI 1.251-4.303, P=0.008). Conclusion: Tumor location of the rectal cancer significantly affected the clinical and oncological outcomes after laparoscopic surgery, and it was an independent predictor of OS and DFS.

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Section: Discussionsupporting

confidence: 94%

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

Yang

Yao

Cui

et al. 2020

Preprint

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“…A low LNH in NACRT patients could either represent either poor oncological clearance and hence inadequate staging or a good response to NACRT and therefore a predictor of good outcome. While some studies show that LNH predicts worse overall survival regardless of NACRT [11,13], majority of the literature are proponents of the notion that a LNH metric may not be clinically relevant in the era of neoadjuvant therapy [9,12,17,18]. Our paper demonstrates that a LNH cut-off of 12 is not significantly associated with poorer DFS and OS in patients who received pre-operative NACRT.…”

Section: Discussionmentioning

confidence: 66%

“…Neoadjuvant chemoradiotherapy (NACRT) is known to decrease the lymph node harvest (LNH) in the resected specimen [3][4][5]. While studies have shown that LNH is associated with recurrence and survival in rectal cancer patients who have undergone upfront surgery [6,7], its prognostic value in patients who have received NACRT is debatable [8][9][10][11][12][13]. Although some studies show that LNH has no significant correlation with recurrence or survival in NACRT patients [9,12], some report that a suboptimal LNH of < 12 independently predicts worse overall survival irrespective of neoadjuvant treatment [11,13].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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 cutoff of 12 is inappropriate in such patients. This paper aims to establish a LNH cutoff 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 cutoffs of 16.5 and 8.5 were obtained for disease-free survival (DFS) and overall survival (OS) respectively. Survival analysis showed that a LNH cutoff 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.

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“…We stated that patients with more LNs had a higher risk of LNM. In some surgical and pathological investigations, the LNs yielding or sampling indicated that the number of LNs in colorectal patients have drawn awareness . The previous study confirmed that in colorectal patients with only one metastatic LN, the 5‐year survival rate was significantly higher than those with greater than or equal to two LNs (67% to 39.6%) .…”

Section: Discussionmentioning

confidence: 88%

“…Morphological features and size of LNs were considered as possible manners to determine LNM. The number of LNs is valued in surgery and pathology, yet little attention has been paid to it on the MRI. Contrast‐enhanced MRI is not a mandatory choice to assess rectal cancer in staging; nevertheless, many approaches are trying to reveal its potential importance …”

Section: Introductionmentioning

confidence: 99%

Value of MRI morphologic features with pT1‐2 rectal cancer in determining lymph node metastasis

Tang

Rao

Yang

et al. 2018

Journal of Surgical Oncology

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Lymph node yield is an independent predictor of survival in rectal cancer regardless of receipt of neoadjuvant therapy

Cited by 37 publications

References 33 publications

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

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

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

Value of MRI morphologic features with pT1‐2 rectal cancer in determining lymph node metastasis

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