Prevalence of nodal involvement in rectal cancer after chemoradiotherapy

Abstract

Background The purpose of this study was to investigate the prevalence of ypN+ status according to ypT category in patients with locally advanced rectal cancer treated with chemoradiotherapy and total mesorectal excision, and to assess the impact of ypN+ on disease recurrence and survival by pooled analysis of individual-patient data. Methods Individual-patient data from 10 studies of chemoradiotherapy for rectal cancer were included. Pooled rates of ypN+ disease were calculated with 95 per cent confidence interval for each ypT category. Kaplan–Meier and Cox regression analyses were undertaken to assess influence of ypN status on 5-year disease-free survival (DFS) and overall survival (OS). Results Data on 1898 patients were included in the study. Median follow-up was 50 (range 0–219) months. The pooled rate of ypN+ disease was 7 per cent for ypT0, 12 per cent for ypT1, 17 per cent for ypT2, 40 per cent for ypT3, and 46 per cent for ypT4 tumours. Patients with ypN+ disease had lower 5-year DFS and OS (46.2 and 63.4 per cent respectively) than patients with ypN0 tumours (74.5 and 83.2 per cent) (P < 0.001). Cox regression analyses showed ypN+ status to be an independent predictor of recurrence and death. Conclusion Risk of nodal metastases (ypN+) after chemoradiotherapy increases with advancing ypT category and needs to be considered if an organ-preserving strategy is contemplated.

A nomogram prediction model for lymph node metastasis risk after neoadjuvant chemoradiotherapy in rectal cancer patients based on SEER database

“…The 5-year overall survival rate of patients with non-pCR in our study was 75.2%, and a study using National Cancer Database (NCDB) data showed a survival rate of 73% (35), which was similar to our findings. Meanwhile, a meta-analysis found that patients with ypN0 and ypN+ disease had 5-year overall survival rates of 83.2% and 63.4%, respectively (34). The rate was also comparable to our study, which was 78.9% and 66.3%, respectively.…”

“…This was consistent with our usual clinical perception. According to a meta-analysis, higher T stage was associated with a higher rate of lymph node metastasis (34). Wang et al found that the risk of lymph node metastasis following neoadjuvant chemoradiotherapy was related to T stage, with the deeper the invasion, the greater the risk of lymph node metastasis (32).…”

Predictive value of proteomic markers for advanced rectal cancer with neoadjuvant chemoradiotherapy

“…TRG alone is not definitive. The ypT and ypN category remain the most important prognostic factors [ 28 ]. We also noted that the levels of HEP2 and GELS correlated with ypT, GELS correlated with ypN, while the level of S10A8 correlated with distant metastasis.…”

An International Expert-Based Consensus on the Definition of a Clinical Near-Complete Response After Neoadjuvant (Chemo)radiotherapy for Rectal Cancer

“…In patients with a cCR after (chemo)radiotherapy, the prevalence of involved lymph nodes is low, approximately 7%. 38 Considering this low prevalence and the risk of overstaging by MRI, the expert panel felt that the presence of 1 single suspicious mesorectal lymph node should not be the decisive factor for organ preservation because it may well be a false-positive finding. Lymph nodes can relatively easily be monitored on MRI, and further observation with careful monitoring of the suspected residual lymph node might be justified, especially when there is a cCR or subcategory "high" nCR in the rectal lumen.…”