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. 2021 Oct 23;108(10):1251-1258.
doi: 10.1093/bjs/znab194.

Prevalence of nodal involvement in rectal cancer after chemoradiotherapy

H E Haak  1   2 , G L Beets  1   2 , K Peeters  3 , P J Nelemans  4 , V Valentini  5 , C Rödel  6 , L Kuo  7 , F A Calvo  8 , J Garcia-Aguilar  9 , R Glynne-Jones  10 , S Pucciarelli  11 , J Suarez  12 , G Theodoropoulos  13 , S Biondo  14   15 , D M J Lambregts  16 , R G H Beets-Tan  2   16 , M Maas  16
Affiliations

Prevalence of nodal involvement in rectal cancer after chemoradiotherapy

H E Haak et al. Br J Surg. .

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.

Plain language summary

When patients are diagnosed with rectal cancer and the tumour grows beyond the rectal wall there is a high risk that the tumour has spread to nearby lymph nodes. This study showed that this relationship between tumour invasion depth and lymph node involvement is similar after treatment with (chemo)radiotherapy. Patients who have tumour cells remaining in the lymph nodes after (chemo) radiotherapy have a worse prognosis than patients who do not have cancer cells remaining in the lymph nodes. When an organ-preserving treatment is considered as an alternative therapy, this should be kept in mind during patient counselling.

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Figures

Fig. 1
Fig. 1
Pooled proportions of ypN+ disease by ypT category a ypT0, b ypT1, c ypT2, d ypT3, and e ypT0. A random-effects model was used for meta-analysis. Proportions are shown with 95 per cent intervals. Heterogeneity is indicated by the I2 value.
Fig. 2
Fig. 2
Survival curves by ypN status for the total patient group a Disease-free survival and b overall survival. a,b P < 0.001 (log rank test).
See this image and copyright information in PMC

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