Lateral node metastasis in low rectal cancer as a hallmark to predict recurrence patterns

Eiji Shinto¹, Hideyuki Ike², Masaaki Ito³, Keiichi Takahashi⁴, Masayuki Ohue⁵, Yukihide Kanemitsu⁶, Takeshi Suto⁷, Tetsushi Kinugasa⁸, Jun Watanabe⁹, Jin-Ichi Hida¹⁰, Michio Itabashi¹¹, Heita Ozawa¹², Hiroaki Nozawa¹³, Yojiro Hashiguchi¹⁴, Kazuo Hase¹⁵, Kenichi Sugihara¹⁶, Yoichi Ajioka¹⁷

Affiliations

¹ Department of Surgery, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, Tokyo, 154-8532, Japan. eiji-c@zf6.so-net.ne.jp.
² Department of Surgery, JCHO Yokohama Hodogaya Central Hospital, 43-1 Kamadai, Hodogaya, Yokohama, Kanagawa, Japan.
³ Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, Japan.
⁴ Department of Surgery, Tokyo Metropolitan Health and Hospitals Corporation Ohkubo Hospital, 2-44-1 Kabuki, Shinjyuku, Tokyo, Japan.
⁵ Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo, Osaka, Japan.
⁶ Department of Colorectal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo, Tokyo, Japan.
⁷ Department of Gastroenterological Surgery, Yamagata Prefectural Central Hospital, Aoyagi, Yamagata, 1800, Japan.
⁸ Fukuokamitsuki Hospital, 1-2-1 Befu, Jonan, Fukuoka, Japan.
⁹ Department of Colorectal Surgery, Kansai Medical University, 5-1 Shinmachi 2 Chome, Hirakata, Osaka, Japan.
¹⁰ Department of Surgery, Kindai University Nara Hospital, Otoda, Ikoma, Nara, 1248-1, Japan.
¹¹ Saiseikai Kazo Hospital, Kamitakayanagi, Kazo, Saitama, 1680, Japan.
¹² Department of Colorectal Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, Japan.
¹³ Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, Japan.
¹⁴ Department of Surgery, Omori Red Cross Hospital, 4-30-1 Chuo, Ota, Tokyo, Japan.
¹⁵ Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, Japan.
¹⁶ Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, Japan.
¹⁷ Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University, 757 Ichibancho, Asahimachi-dori, Chuo Ward, Niigata, Japan.

PMID: 39402391
DOI: 10.1007/s10147-024-02630-z

Lateral node metastasis in low rectal cancer as a hallmark to predict recurrence patterns

Eiji Shinto et al. Int J Clin Oncol. 2024 Dec.

. 2024 Dec;29(12):1896-1907.

doi: 10.1007/s10147-024-02630-z. Epub 2024 Oct 14.

Authors

Affiliations

¹ Department of Surgery, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, Tokyo, 154-8532, Japan. eiji-c@zf6.so-net.ne.jp.
² Department of Surgery, JCHO Yokohama Hodogaya Central Hospital, 43-1 Kamadai, Hodogaya, Yokohama, Kanagawa, Japan.
³ Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, Japan.
⁴ Department of Surgery, Tokyo Metropolitan Health and Hospitals Corporation Ohkubo Hospital, 2-44-1 Kabuki, Shinjyuku, Tokyo, Japan.
⁵ Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo, Osaka, Japan.
⁶ Department of Colorectal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo, Tokyo, Japan.
⁷ Department of Gastroenterological Surgery, Yamagata Prefectural Central Hospital, Aoyagi, Yamagata, 1800, Japan.
⁸ Fukuokamitsuki Hospital, 1-2-1 Befu, Jonan, Fukuoka, Japan.
⁹ Department of Colorectal Surgery, Kansai Medical University, 5-1 Shinmachi 2 Chome, Hirakata, Osaka, Japan.
¹⁰ Department of Surgery, Kindai University Nara Hospital, Otoda, Ikoma, Nara, 1248-1, Japan.
¹¹ Saiseikai Kazo Hospital, Kamitakayanagi, Kazo, Saitama, 1680, Japan.
¹² Department of Colorectal Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, Japan.
¹³ Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, Japan.
¹⁴ Department of Surgery, Omori Red Cross Hospital, 4-30-1 Chuo, Ota, Tokyo, Japan.
¹⁵ Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, Japan.
¹⁶ Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, Japan.
¹⁷ Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University, 757 Ichibancho, Asahimachi-dori, Chuo Ward, Niigata, Japan.

PMID: 39402391
DOI: 10.1007/s10147-024-02630-z

Abstract

Background: Lateral node metastasis confers a poor prognosis in rectal cancer. Several multidisciplinary treatments have been proposed with favorable outcomes. However, appropriate neoadjuvant/adjuvant treatments or follow-up plans based on information about the probable recurrence site have not been specified. We aimed to clarify the distinctive features of recurrence patterns for lateral node-positive low rectal cancer according to the lateral and mesorectal lymph node status.

Methods: We retrospectively analyzed 508 patients with stage III low rectal cancer who underwent lateral node dissection. We investigated the impact of lateral and mesorectal lymph node status on site-specific recurrence rates and patient survival.

Results: Analyses for relapse-free survival revealed the prognostic impact of lateral node positivity in stage III low rectal cancer (p < 0.0001). Lateral node-positive patients exhibited higher risk of overall recurrence, local recurrence, and recurrence in extra-regional nodes than lateral node-negative patients (p < 0.0001, p = 0.001, and p < 0.0001, respectively). However, lateral node positivity was not statistically associated with a hematogenous recurrence rate. In lateral node-positive patients, both tumor-node-metastasis (TNM)-N status and number of lateral nodes involved were revealed as significant prognostic factors (p < 0.0001, both). In addition, the number of lateral nodes involved could be a discriminatory indicator of probabilities of local recurrence and recurrence in extra-regional nodes (p = 0.02, and p < 0.0001, respectively).

Conclusions: Lateral node-positive low rectal cancer exhibits higher local recurrence and extra-regional node recurrence rates that correlate with the number of lateral nodes involved.

Keywords: Lateral node metastasis; Local recurrence; Prognosis; Recurrence in extra-regional nodes; Stage III low rectal cancer.

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Conflict of interest statement

Declarations. Conflict of interest: We have nothing to disclose. Ethics approval: The study protocol was approved by the ethical review board of the Japanese Society for Cancer of the Colon and Rectum (Protocol number: 90–3) and by the institutional review board of each participating institution. The study was performed in accordance with the Declaration of Helsinki. Informed consent: Written informed consent was obtained from all patients in accordance with their respective institutional regulations.

References

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Lateral node metastasis in low rectal cancer as a hallmark to predict recurrence patterns

Affiliations

Lateral node metastasis in low rectal cancer as a hallmark to predict recurrence patterns

Authors

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

LinkOut - more resources

Full Text Sources