Lymph Nodes After Preoperative Chemoradiotherapy for Rectal Carcinoma: Number, Status, and Impact on Survival
- 1 January 2008
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in The American Journal of Surgical Pathology
- Vol. 32 (1), 45-50
- https://doi.org/10.1097/pas.0b013e3180dc92ab
Abstract
The number and status of lymph nodes examined is crucial for tumor staging. Impact of preoperative chemoradiotherapy on lymph nodes status and survival is still controversial in rectal carcinoma. The aim of this study was (i) to define the impact of preoperative chemoradiotherapy on the number of both retrieved and positive lymph nodes in rectal cancer specimen, (ii) to evaluate the influence of the number of lymph nodes retrieved on survival in patients treated by preoperative chemoradiotherapy. From 1994 to 2004, 495 patients underwent rectal excision for cancer, of which 332 received long course preoperative radiotherapy. Surgery and pathologic assessment were standardized. Multivariate analysis evaluated the influence of clinical and pathologic variables on the number of both retrieved and positive lymph nodes. Kaplan-Meier method and log-rank test assessed the relation between survival and the number of lymph nodes retrieved in patients treated by preoperative chemoradiotherapy. Compared with surgery alone, preoperative chemoradiotherapy decreased both the mean number of lymph nodes retrieved (17 vs. 13; P<0.001) and the mean number of positive lymph nodes (2.3 vs. 1.2; P=0.001). Multivariate analysis confirmed the independent impact of preoperative chemoradiotherapy on retrieved and positive lymph nodes. In patients treated by preoperative chemoradiotherapy, the 5-year overall (71%) and disease-free (60%) survival was not associated with the number of lymph nodes retrieved. Although long course preoperative chemoradiotherapy decreases by 24%, the mean number of lymph nodes retrieved and by 48% the mean number of positive lymph nodes, survival was not influenced by the number of lymph nodes retrieved in irradiated rectal specimen.Keywords
This publication has 24 references indexed in Scilit:
- Preoperative radiotherapy for rectal adenocarcinoma: Which are strong prognostic factors?International Journal of Radiation Oncology*Biology*Physics, 2005
- Impact of preoperative radiation for rectal cancer on subsequent lymph node evaluation: A population-based analysisInternational Journal of Radiation Oncology*Biology*Physics, 2005
- Lymph Node Evaluation in Colorectal Cancer Patients: A Population-Based StudyJNCI Journal of the National Cancer Institute, 2005
- Influence of obesity on lymph node recovery from rectal resection specimens.Pathology and Oncology Research, 2003
- Prognostic Factors in Colorectal CancerArchives Of Pathology & Laboratory Medicine, 2000
- Influence of the Interval Between Preoperative Radiation Therapy and Surgery on Downstaging and on the Rate of Sphincter-Sparing Surgery for Rectal Cancer: The Lyon R90-01 Randomized TrialJournal of Clinical Oncology, 1999
- For patients with dukes' B (TNM stage II) colorectal carcinoma, examination of six or fewer lymph nodes is Related to poor prognosisCancer, 1998
- Lymph Node Recovery From Colorectal Resection Specimens Removed for Adenocarcinoma:Trends Over Time and a Recommendation for a Minimum Number of Lymph Nodes to be RecoveredAmerican Journal of Clinical Pathology, 1996
- Clinicopathological staging for colorectal cancer: An International Documentation System (IDS) and an International Comprehensive Anatomical Terminology (ICAT)Journal of Gastroenterology and Hepatology, 1991
- Number and size of lymph nodes and node metastases in rectal carcinomasSurgical Endoscopy, 1989