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Reduced Lymph Node Yield in Rectal Carcinoma Specimen After Neoadjuvant Radiochemotherapy Has No Prognostic Relevance

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Abstract

Background

In colorectal surgery UICC/AJCC criteria require a yield of 12 or more locoregional lymph nodes for adequate staging. Neoadjuvant radiochemotherapy for rectal carcinoma reduces the number of lymph nodes in the resection specimen; the prognostic impact of this reduced lymph node yield has not been determined.

Methods

One hundred two patients with uT3 rectal carcinoma who were receiving neoadjuvant radiochemotherapy were compared with 114 patients with uT3 rectal carcinoma who were receiving primary surgery followed by adjuvant radiochemotherapy. Total lymph node yield and number of tumor-positive lymph nodes were determined and correlated with survival.

Results

After neoadjuvant radiochemotherapy both total lymph node yield (12.9 vs. 21.4, p < 0.0001) and number of tumor-positive lymph nodes (1.0 vs. 2.3, p = 0.014) were significantly lower than after primary surgery plus adjuvant radiochemotherapy. Reduced total lymph node yield in neoadjuvantly treated patients had no prognostic impact, with overall survival of patients with 12 or more lymph nodes the same as that of patients with less than 12 lymph nodes. Overall survival of neoadjuvantly treated patients was significantly influenced by the number of tumor-positive lymph nodes with 5-year-survival rates of 88, 63, and 39% for 0, 1–3, and more than 3 positive lymph nodes (p < 0.0001).

Conclusion

The UICC/AJCC criterion of a total lymph node yield of 12 or more should be revised for rectal carcinoma patients.

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References

  1. Jemal A, Siegel R, Ward E et al (2007) Cancer Statistics 2007. CA Cancer J Clin 57:43–66

    Article  PubMed  Google Scholar 

  2. Tepper JE, O’Connell MJ, Petroni GR et al (1997) Adjuvant postoperative fluorouracil-modulated chemotherapy combined with pelvic radiation therapy for rectal cancer: initial results of Intergroup 0114. J Clin Oncol 15:2030–2039

    PubMed  CAS  Google Scholar 

  3. Kobayashi H, Ueno H, Hashiguchi Y et al (2006) Distribution of lymph node metastasis is a prognostic index in patients with stage III colon cancer. Surgery 139:516–522

    Article  PubMed  Google Scholar 

  4. Berger AC, Sigurdson ER, LeVoyer T et al (2005) Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol 23:8706–8712

    Article  PubMed  Google Scholar 

  5. Tocchi A, Mazzoni G, Lepre L et al (2001) Total mesorectal excision and low rectal anastomosis for the treatment of rectal cancer and prevention of pelvic recurrences. Arch Surg 136:216–220

    Article  PubMed  CAS  Google Scholar 

  6. van den Brink M, Stiggelbout AM, van den Hout WB et al (2004) Clinical nature and prognosis of locally recurrent rectal cancer after total mesorectal excision with or without preoperative radiotherapy. J Clin Oncol 22:3958–3964

    Article  PubMed  Google Scholar 

  7. Johnson PM, Malatjalian D, Porter GA (2002) Adequacy of nodal harvest in colorectal cancer: a consecutive cohort study. J Gastrointest Surg 6:883–888

    Article  PubMed  Google Scholar 

  8. Chang GJ, Rodriguez-Bigas MA, Skibber JM et al (2007) Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 99:433–441

    Article  PubMed  Google Scholar 

  9. George S, Primrose J, Talbot R et al (2006) Will Rogers revisited: prospective observational study of survival of 3592 patients with colorectal cancer according to number of nodes examined by pathologists. Br J Cancer 95:841–847

    Article  PubMed  CAS  Google Scholar 

  10. Swanson RS, Compton CC, Stewart AK et al (2003) The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Oncol 10:65–71

    Article  PubMed  Google Scholar 

  11. Lee HY, Choi HJ, Park KJ et al (2007) Prognostic significance of metastatic lymph node ratio in node-positive colon carcinoma. Ann Surg Oncol 14:1712–1717

    Article  PubMed  Google Scholar 

  12. Maurel J, Launoy G, Grosclaude P et al (1998) Lymph node harvest reporting in patients with carcinoma of the large bowel: a French population-based study. Cancer 82:1482–1486

    Article  PubMed  CAS  Google Scholar 

  13. Yoshimatsu K, Ishibashi K, Umehara A et al (2005) How many lymph nodes should be examined in Dukes’ B colorectal cancer? Determination on the basis of cumulative survival rate. Hepatogastroenterology 52:1703–1706

    PubMed  Google Scholar 

  14. Luna-Perez P, Trejo-Valdivia B, Labastida S et al (1999) Prognostic factors in patients with locally advanced rectal adenocarcinoma treated with preoperative radiotherapy and surgery. World J Surg 23:1069–1074

    Article  PubMed  CAS  Google Scholar 

  15. Prandi M, Lionetto R, Bini A et al (2002) Prognostic evaluation of stage B colon cancer patients is improved by an adequate lymphadenectomy: results of a secondary analysis of a large scale adjuvant trial. Ann Surg 235:458–463

    Article  PubMed  Google Scholar 

  16. Sobin LH, Wittekind C (eds) (1997) TNM classification of malignant tumours, 5th edn. Wiley-Liss, New York

  17. Sobin LH, Greene FL (2001) TNM classification: clarification of number of regional lymph nodes for pN0. Cancer 92:452

    Article  PubMed  CAS  Google Scholar 

  18. Schmiegel W, Pox C, Adler G et al (2004) S3-Guidelines Conference “Colorectal Cancer” 2004. Z Gastroenterol 42:1129–1177

    Article  PubMed  CAS  Google Scholar 

  19. Camma C, Giunta M, Fiorica M et al (2000) Preoperative radiotherapy for resectable rectal cancer. A meta-analysis. JAMA 284:1008–1015

    Article  PubMed  CAS  Google Scholar 

  20. Kapiteijn E, Marijnen CA, Nagtegaal ID et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646

    Article  PubMed  CAS  Google Scholar 

  21. Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740

    Article  PubMed  CAS  Google Scholar 

  22. Rosenberg R, Nekarda H, Zimmermann F et al (2008) Histopathological response after preoperative radiochemotherapy in rectal carcinoma is associated with improved overall survival. J Surg Oncol 97:8–13

    Article  PubMed  CAS  Google Scholar 

  23. Party Medical Research Council Rectal Cancer Working (1982) A trial of preoperative radiotherapy in the management of operable rectal cancer. Br J Surg 69:513–519

    Article  Google Scholar 

  24. Horn A, Morild I, Dahl O (1990) Tumour shrinkage and down staging after preoperative radiation of rectal adenocarcinomas. Radiother Oncol 18:19–28

    Article  PubMed  CAS  Google Scholar 

  25. Party Medical Research Council Rectal Cancer Working (1996) Randomised trial of surgery alone versus surgery followed by radiotherapy for mobile cancer of the rectum. Lancet 348:1610–1614

    Article  Google Scholar 

  26. Marijnen CA, Nagtegaal ID, Klein Kranenbarg E et al (2001) No downstaging after short-term preoperative radiotherapy in rectal cancer patients. J Clin Oncol 19:1976–1984

    PubMed  CAS  Google Scholar 

  27. Sermier A, Gervaz P, Egger JF et al (2006) Lymph node retrieval in abdominoperineal surgical specimen is radiation time-dependent. World J Surg Oncol 4:29

    Article  PubMed  Google Scholar 

  28. Wheeler JM, Warren BF, Mortensen NJ et al (2002) Quantification of histologic regression of rectal cancer after irradiation: a proposal for a modified staging system. Dis Colon Rectum 45:1051–1056

    Article  PubMed  CAS  Google Scholar 

  29. Wichmann MW, Muller C, Meyer G et al (2002) Effect of preoperative radiochemotherapy on lymph node retrieval after resection of rectal cancer. Arch Surg 137:206–210

    Article  PubMed  Google Scholar 

  30. Wijesuriya RE, Deen KI, Hewavisenthi J et al (2005) Neoadjuvant therapy for rectal cancer down-stages the tumour but reduces lymph node harvest significantly. Surg Today 35:442–445

    Article  PubMed  CAS  Google Scholar 

  31. Baxter NN, Morris AM, Rothenberger DA et al (2005) Impact of preoperative radiation for rectal cancer on subsequent lymph node evaluation: a population-based analysis. Int J Radiol Oncol Biol Phys 61:426–431

    Article  Google Scholar 

  32. NIH consensus conference (1990) Adjuvant therapy for patients with colon and rectal cancer. JAMA 264:1444–1450

    Article  Google Scholar 

  33. O’Connell MJ, Martenson JA, Wieand HS et al (1994) Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. N Engl J Med 331:502–507

    Article  PubMed  CAS  Google Scholar 

  34. Becker K, Mueller JD, Schuhmacher C et al (2003) Histomorphology and grading of regression in gastric carcinoma treated with neoadjuvant chemotherapy. Cancer 98:1521–1530

    Article  PubMed  Google Scholar 

  35. Francois Y, Nernoz CJ, Baulieux J et al (1999) 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 trial. J Clin Oncol 17:279–286

    Google Scholar 

  36. Moore HG, Gittleman AE, Minsky BD et al (2004) Rate of pathologic complete response with increased interval between preoperative combined modality and rectal cancer resection. Dis Colon Rectum 47:279–286

    Article  PubMed  Google Scholar 

  37. Farjardo LF (1994) Effects of ionizing radiation on lymph nodes. Front Radiat Ther Oncol 28:37–45

    Google Scholar 

  38. Shvero J, Koren R, Marshak G et al (2001) Histological changes in the cervical lymph nodes after radiotherapy. Oncol Rep 8:909–911

    PubMed  CAS  Google Scholar 

  39. Thorn CC, Woodcock NP, Scott N et al (2004) What factors affect lymph node yield in surgery for rectal cancer? Colorectal Dis 6:356–361

    Article  PubMed  CAS  Google Scholar 

  40. Sarli L, Bader G, Iusco D et al (2005) Number of lymph nodes examined and prognosis of TNM stage II colorectal cancer. Eur J Cancer 41:272–279

    Article  PubMed  Google Scholar 

  41. Jass JR, O’Brien MJ, Riddell RH et al (2007) Recommendations for the reporting of surgically resected specimens of colorectal carcinoma. Hum Pathol 38:537–545

    Article  PubMed  Google Scholar 

  42. Kim NK, Baik SH, Seong JS et al (2006) Oncologic outcomes after neoadjuvant chemoradiation followed by curative resection with tumour-specific mesorectal excision for fixed locally advanced rectal cancer: Impact of postirradiated pathologic downstaging on local recurrence and survival. Ann Surg 244:1024–1030

    Article  PubMed  Google Scholar 

  43. Rosenberg R, Friederichs J, Gertler R et al (2004) Prognostic evaluation and review of immunohistochemically detected disseminated tumour cells in peritumoural lymph nodes of patients with pN0 colorectal cancer. Int J Colorectal Dis 19:430–437

    Article  PubMed  Google Scholar 

  44. Friederichs J, Rosenberg R, Mages J et al (2005) Gene expression profiles of different clinical stages of colorectal carcinoma: toward a molecular genetic understanding of tumour progression. Int J Colorectal Dis 20:391–402

    Article  PubMed  Google Scholar 

  45. Beresford M, Glynne-Jones R, Richman P et al (2005) The reliability of lymph node staging in rectal cancer after preoperative chemoradiotherapy. Clin Oncol (R Coll Radiol) 17:448–455

    CAS  Google Scholar 

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Authors and Affiliations

  1. Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany

    Dietrich Doll, Ralf Gertler, Matthias Maak, Jan Friederichs, Hjalmar Nekarda, Jörg R. Siewert & Robert Rosenberg

  2. Institut für Pathologie und Pathologische Anatomie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Karen Becker

  3. Klinik für Strahlentherapie und Radiologische Onkologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Hans Geinitz

  4. Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Monika Kriner

Authors
  1. Dietrich Doll
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  2. Ralf Gertler
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  3. Matthias Maak
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  4. Jan Friederichs
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  10. Robert Rosenberg
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Correspondence to Dietrich Doll.

Additional information

D. Doll and R. Gertler contributed equally to this work.

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Doll, D., Gertler, R., Maak, M. et al. Reduced Lymph Node Yield in Rectal Carcinoma Specimen After Neoadjuvant Radiochemotherapy Has No Prognostic Relevance. World J Surg 33, 340–347 (2009). https://doi.org/10.1007/s00268-008-9838-8

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  • DOI: https://doi.org/10.1007/s00268-008-9838-8

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