Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar 20;18(1):58.
doi: 10.1186/s12957-020-01833-8.

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

Charleen Shanwen Yeo  1 , Nicholas Syn  2 , Huimin Liu  3 , Sau Shung Fong  4
Affiliations

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

Charleen Shanwen Yeo et al. World J Surg Oncol. .

Abstract

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

Keywords: Chemotherapy; Lymph node; Neoadjuvant; Radiotherapy; Rectal cancer.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Hazard ratio plots to determine optimal lymph node (LN) cut-offs for disease-free survival (DFS) and overall survival (OS) in the neoadjuvant chemoradiotherapy (NACRT) group. a Hazard ratio plot for DFS (LN cut-off 16.5). b Hazard ratio plot for OS (LN cut-off 8.5)
Fig. 2
Fig. 2
Kaplan-Meier survival curves to compare disease-free survival (DFS) and overall survival (OS) based on lymph node (LN) cut-offs in the neoadjuvant chemoradiotherapy (NACRT) group. a Kaplan-Meier survival curves to comparing DFS based on LN cut-off 16.5. b Kaplan-Meier survival curves to comparing OS based on LN cut-off 8.5
See this image and copyright information in PMC

References

    1. Compton CC, Fielding LP, Burgart LJ, Conley B, Cooper HS, Hamilton SR, Hammond ME, Henson DE, Hutter RV, Nagle RB, Nielsen ML, Sargent DJ, Taylor CR, Welton M, Willett C. Prognostic factors in colorectal cancer. College of American Pathologists Consensus Statement 1999. Archives of pathology & laboratory medicine. 2000;124(7):979–994. doi: 10.1043/0003-9985(2000)124<0979:Pficc>2.0.Co;2. - DOI - PubMed
    1. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Annals of surgical oncology. 2010;17(6):1471–1474. doi: 10.1245/s10434-010-0985-4. - DOI - PubMed
    1. Miller ED, Robb BW, Cummings OW, Johnstone PA. The effects of preoperative chemoradiotherapy on lymph node sampling in rectal cancer. Diseases of the colon and rectum. 2012;55(9):1002–1007. doi: 10.1097/DCR.0b013e3182536d70. - DOI - PubMed
    1. Ha YH, Jeong SY, Lim SB, Choi HS, Hong YS, Chang HJ, Kim DY, Jung KH, Park JG. Influence of preoperative chemoradiotherapy on the number of lymph nodes retrieved in rectal cancer. Annals of surgery. 2010;252(2):336–340. doi: 10.1097/SLA.0b013e3181e61e33. - DOI - PubMed
    1. Amajoyi Robert, Lee Yoori, Recio Patrick J., Kondylis Philip D. Neoadjuvant therapy for rectal cancer decreases the number of lymph nodes harvested in operative specimens. The American Journal of Surgery. 2013;205(3):289–292. doi: 10.1016/j.amjsurg.2012.10.020. - DOI - PubMed

LinkOut - more resources