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. 2015 Aug 15;8(8):12801-9.
eCollection 2015.

Survival implications of pretreatment pelvic CT in rectal cancer patients after neoadjuvant chemoradiotherapy and surgery

Chunyan Cui  1 , Min Zhang  2 , Li Tian  1 , Wu Jiang  3 , Zhifang Zeng  4 , Li Li  1
Affiliations

Survival implications of pretreatment pelvic CT in rectal cancer patients after neoadjuvant chemoradiotherapy and surgery

Chunyan Cui et al. Int J Clin Exp Med. .

Abstract

Purpose: To determine the correlation between pretreatment computed tomography (CT) data and survival duration after neoadjuvant chemoradiotherapy and surgery for locally advanced rectal cancer.

Materials and methods: 122 consecutive patients with advanced rectal cancer were assessed retrospectively. Pretreatment imaging and postoperative data were evaluated through Kaplan-Meier and Cox proportional hazard regression analyses.

Results: Pretreatment CT identified 557 metastatic lymph nodes (mean, 4.55 per patient; median 4). Survival durations were measured during the period between the application of CT and death or the last follow-up examination. Univariate analysis showed that the following factors had a significant impact on survival: maximum tumor diameter (P = 0.019), distance from inferior tumor margin to anorectal ring (P <0.0001), number of lymph nodes involved in patients with short-axis, lymph node diameter ≥8 mm (P <0.0001) in pretreatment CT, distance from the anorectal ring (P = 0.027), ypN stage (P = 0.0008), ypM stage (P = 0.046) and number of metastatic lymph nodes (P <0.0001) in clinical assessment. Multivariate analysis showed that the following factors were significant: number of lymph nodes in patients with short-axis lymph node diameter ≥5 mm but <8 mm (P = 0.044) and in those with this diameter ≥8 mm (P = 0.028; pretreatment CT) and number of metastatic lymph nodes (assessed in histopathological examination).

Conclusion: Pretreatment lymph node size and number can predict survival duration after treatment for locally advanced rectal cancer. For patients with lymph nodes >8 mm (short-axis diameter) and/or >1, such lymph nodes tend to have a poor performance for prognosis.

Keywords: Locally advanced rectal cancer; lymph node size; multislice spiral CT; survival.

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Figures

Figure 1
Figure 1
Computed tomography scans of regional lymph nodes (A, B: Arrows) and lymph nodes near the right iliac vessels (C, D: Arrows) showing metastases from rectal cancer.
Figure 2
Figure 2
Overall survival was significantly greater in patients with maximum short-axis lymph node diameter <8 mm, as measured on pretreatment computed tomography, than in patients with this diameter ≥8 mm (P <0.001).
Figure 3
Figure 3
No significant difference in overall survival was observed between patients with maximum short-axis lymph node diameter <3 mm, as measured on pretreatment computed tomography, and patients with this diameter ≥3 mm (P = 0.573).
Figure 4
Figure 4
No significant difference in overall survival was observed between patients with maximum short-axis lymph node diameter <5 mm, as measured on pretreatment computed tomography, and patients with this diameter ≥5 mm (P = 0.343).
See this image and copyright information in PMC

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