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
Observational Study
. 2020 Sep;72(3):793-800.
doi: 10.1007/s13304-020-00841-3. Epub 2020 Jul 6.

The prognostic impact of neoadjuvant chemoradiotherapy on lymph node sampling in patients with locally advanced rectal cancer

Giovanni Li Destri  1 , Andrea Maugeri  2 , Alice Ramistella  2 , Gaetano La Greca  2 , Pietro Conti  3 , Giovanni Trombatore  3 , Giada Maria Vecchio  2 , Gaetano Giuseppe Magro  2 , Martina Barchitta  2 , Antonella Agodi  2
Affiliations
Observational Study

The prognostic impact of neoadjuvant chemoradiotherapy on lymph node sampling in patients with locally advanced rectal cancer

Giovanni Li Destri et al. Updates Surg. 2020 Sep.

Abstract

According to the American Joint Committee on Cancer, at least 12 lymph nodes are required to accurately stage locally advanced rectal cancer (LARC). Neoadjuvant chemoradiation therapy (NACRT) reduces the number of lymph nodes retrieved during surgery. In this study, we evaluated the effect of NACRT on lymph node retrieval and prognosis in patients with LARC. We performed an observational study of 142 patients with LARC. Although our analysis was retrospective, data were collected prospectively. Half the patients were treated with NACRT and total mesorectal excision (TME) and the other half underwent TME only. The number of lymph nodes retrieved and the number of metastatic lymph nodes were significantly reduced in the NACRT group (P > 0.001). In the univariate and multivariate analyses, only NACRT and patient age were significantly associated with reduced lymph node retrieval. The number of metastatic lymph nodes and the lymph node ratio (LNR) both had a significant effect on prognosis when the patient population was examined as a whole (P = 0.003 and P = 0.001, respectively). However, the LNR was the only significant, independent prognostic factor in both treatment groups (P = 0.007 for the NACRT group; P = 0.04 for the no-NACRT group). NACRT improves patient prognosis only when the number of metastatic lymph nodes is reduced. The number of metastatic lymph nodes and the LNR are important prognostic factors. Lymph node retrieval remains an indispensable tool for staging and prognostic assessment of patients with rectal carcinoma treated with NACRT.

Keywords: Lymph node ratio; Lymph node sampling; Neoadjuvant chemoradiotherapy; Rectal cancer.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Kaplan–Meier analysis of disease-free survival in patients with locally advanced rectal cancer. NACRT neoadjuvant chemoradiotherapy
Fig. 2
Fig. 2
ROC curve analysis of predictors of relapse in patients with locally advanced rectal cancer
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Scarinci A, Di Cesare T, Cavaniglia D, Neri T, Colletti M, Cosenza G, Liverani A. The impact of log odds of positive lymph nodes (LODDS) in colon and rectal cancer patient stratification: a single-center analysis of 323 patients. Updates Surg. 2018;70:23–31. doi: 10.1007/s13304-018-0519-3. - DOI - PMC - PubMed
    1. Jin C, Deng X, Li Y, He W, Yang X, Liu J. Lymph node ratio is an independent prognostic factor for rectal cancer after neoadjuvant therapy: a meta-analysis. J Evid Based Med. 2018;11:169–175. doi: 10.1111/jebm.12289. - DOI - PubMed
    1. Bustamante-Lopez L, Nahas CS, Nahas SC, Ribeiro U, Jr, Marques CF, Cotti G, Rocco A, Cecconello I. Understanding the factors associated with reduction in the number of lymph nodes in rectal cancer patients treated by neoadjuvant treatment. Int J Colorectal Dis. 2017;32:925–927. doi: 10.1007/s00384-016-2747-7. - DOI - PubMed
    1. Mechera R, Schuster T, Rosenberg R, Speich B. Lymph node yield after rectal resection in patients treated with neoadjuvant radiation for rectal cancer: a systematic review and meta-analysis. Eur J Cancer. 2017;72:84–94. doi: 10.1016/j.ejca.2016.10.031. - DOI - PubMed
    1. Gurawalia J, Dev K, Nayak SP, Kurpad V, Pandey A. Less than 12 lymph nodes in the surgical specimen after neoadjuvant chemo-radiotherapy: an indicator of tumor regression in locally advanced rectal cancer? J Gastrointest Oncol. 2016;7:946–957. doi: 10.21037/jgo.2016.09.03. - DOI - PMC - PubMed

Publication types

LinkOut - more resources