Prognostic value of pathological node status after neoadjuvant radiotherapy for rectal cancer

Duchalais, Emilie; Mullaney, Tamara G.; Spears, Grant M.; Kelley, Scott R.; Mathis, Kellie L.; Harmsen, William S.; Larson, David W.

doi:10.1002/bjs.10867

Cited by 17 publications

(10 citation statements)

References 29 publications

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“…The indication for liver surgery has widened regarding number and size of metastases 11 , but is limited by the need for an adequate remnant liver volume and extrahepatic disease. The importance of liver surgery specialist participation in multidisciplinary boards has been emphasized, to increase the use of curative strategies 12 -14 . Five-year overall survival (OS) rates of 40-60 per cent Age, high BMI and co-morbidity are known risk factors for poor survival in patients with colorectal cancer 22 -24 . Lymph node status of the primary tumour is a well recognized prognostic factor 25 , although preoperative chemotherapy might modify its importance 26,27 . Lymphovascular and perineural invasion have also been attributed as independent factors for survival 28,29 .…”

Section: Introductionmentioning

confidence: 99%

Influence of primary tumour and patient factors on survival in patients undergoing curative resection and treatment for liver metastases from colorectal cancer

et al. 2020

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Background: Resection of the primary tumour is a prerequisite for cure in patients with colorectal cancer, but hepatic metastasectomy has been used increasingly with curative intent. This national registry study examined prognostic factors for radically treated primary tumours, including the subgroup of patients undergoing liver metastasectomy. Methods: Patients who had radical resection of primary colorectal cancer in 2009-2013 were identified in a population-based Swedish colorectal registry and cross-checked in a registry of liver tumours. Data on primary tumour and patient characteristics were extracted and prognostic impact was analysed.Results: Radical resection was registered in 20 853 patients; in 38⋅7 per cent of those registered with liver metastases, surgery or ablation was performed. The age-standardized relative 5-year survival rate after radical resection of colorectal cancer was 80⋅9 (95 per cent c.i. 80⋅2 to 81⋅6) per cent, and the rate after surgery for colorectal liver metastases was 49⋅6 (46⋅0 to 53⋅2) per cent. Multivariable analysis identified lymph node status, multiple sites of metastasis, high ASA grade and postoperative complications after resection of the primary tumour as strong risk factors after primary resection and following subsequent liver resection or ablation. Age, sex and primary tumour location had no prognostic impact on mortality after liver resection.Conclusion: Lymph node status and complications have a negative impact on outcome after both primary resection and liver surgery. Older age and female sex were underrepresented in the liver surgical cohort, but these factors did not influence prognosis significantly.

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Section: Introductionmentioning

confidence: 99%

Influence of primary tumour and patient factors on survival in patients undergoing curative resection and treatment for liver metastases from colorectal cancer

et al. 2020

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“…Delaying surgery for patients who presented with good clinical outcomes has gained popularity recently (7,8). It was reported that following preop-CRT in rectal cancer, persistent lymph node metastasis (LNM) was the most indicative factor of poor prognosis (9,10). In addition, yp node (ypN) positivity (metastatic lymph node detection after surgery) was revealed to be the most important prognostic factor to predict the survival of patients harboring no residual tumor (ypT0) following surgical resection (2).…”

Section: Introductionmentioning

confidence: 99%

Prediction of tumor response of rectal cancer cells via 3D cell culture and in�vitro cytotoxicity assay before initiating preoperative chemoradiotherapy

Kang

Park²,

Kim³

et al. 2019

Oncol Lett

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The aim of the present study was to investigate the utility of 3D cell culture and in vitro cytotoxicity assays, performed using cells derived from biopsies obtained prior to the initiation of preoperative chemoradiotherapy (preop-CRT), in predicting tumor response to chemoradiotherapy following preop-CRT in rectal cancer. Biopsies were obtained from 49 patients with locally advanced rectal cancer that underwent preop-CRT between August 2015 and March 2017. Tumor tissue was obtained before initiating preop-CRT. The response to chemoradiation was assessed by in vitro cytotoxicity assay following 3D cell culture and radiation treatment. The associations between the results from the cytotoxicity assay, and tumor regression grade (TRG) and yp node (ypN) positivity were investigated. Among 49 patients, 26 patients were available for analysis. Cytotoxicity ranged from 25.5-72.6% (median, 47.6%). There was no difference in cytotoxicity according to the TRGs 1-5 (P=0.940), or good tumor response (TRGs 1-2 vs. TRGs 3-5; P=0.729). However, there was a significant difference in cytotoxicity between the ypN-negative and -positive groups (53.2±14.1 and 38.7±10.1, respectively; P=0.021). Following dichotomization of patients with 45% cut-off value, the cytotoxicity assay was the only factor that predicted ypN positivity in multivariate analysis (odds ratio, 13; 95% confidence interval, 1.2-133.2; P= 0.031). In conclusion, the cytotoxicity assay using the 3D cell culture method can be used to predict tumor response, particularly ypN positivity, in patients with rectal cancer who are scheduled for preop-CRT.

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“…We read the recent article by Duchalais and colleagues, with great interest. There are several aspects of the article with which one might take issue.…”

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confidence: 99%

“…Finally, a recent study has pointed to LN ratio as a more effective indicator of oncological adequacy in node‐positive rectal cancer compared to ypN stage. Again, no attempt was made to include both LN ratio and ypN stage in the same multivariate model in the study by Duchalais et al …”

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confidence: 99%

Correspondence

Hamid¹

2019

British Journal of Surgery

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We read the recent article by Duchalais and colleagues 1 , with great interest. There are several aspects of the article with which one might take issue.First, the multivariate analysis yielded that a smaller number of lymph nodes (LNs) was independently associated with shorter overall survival. Although the authors included a large number of rectal cancer patients, no subgroup analysis was performed. Studies have shown that a lower LN retrieval in patients with

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Prognostic value of pathological node status after neoadjuvant radiotherapy for rectal cancer

Abstract: Both ypT and ypN status is of prognostic significance following neoadjuvant therapy for rectal cancer.

Cited by 17 publications

References 29 publications

Influence of primary tumour and patient factors on survival in patients undergoing curative resection and treatment for liver metastases from colorectal cancer

Influence of primary tumour and patient factors on survival in patients undergoing curative resection and treatment for liver metastases from colorectal cancer

Prediction of tumor response of rectal cancer cells via 3D cell culture and in�vitro cytotoxicity assay before initiating preoperative chemoradiotherapy

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