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Prognostic value of lymph node ratio in resectable rectal cancer after preoperative short-course radiotherapy—results from randomized clinical trial

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Abstract

Purpose

The value of the lymph node ratio (LNR) in patients with rectal cancer has not yet been unequivocally established. This study aims to assess the effect of the lymph node ratio on the prognosis of rectal cancer in patients operated after short-course preoperative 25 Gy radiotherapy, at 10-year follow-up.

Methods

This is a substudy based on data from a prospective randomized clinical trial. A total of 141 patients with resectable rectal cancer were included. Lymph node yield was compared in patients with short and long time intervals between radiotherapy and surgery. Survival curves were compared between patients with different ypN and LNR categories. Univariate and multivariate analyses were performed to identify independent prognostic factors for overall survival and disease-free survival.

Results

Survival and recurrence data were available for a median follow-up of 11.6 years. The lymph node yield did not differ significantly between the patients in the short- and long-interval groups.

A greater difference in 10-year survival was observed in patients with LNR ≤ 0.41 and > 0.41 when compared to the ypN categories. Separate prognostic factor analyses were performed for the entire population and for subgroups that had < 12 and 12 lymph nodes resected. LNR was identified as an independent prognostic factor for overall survival, in multivariate analyses, for all patients and those with less than 12 retrieved lymph nodes.

Conclusion

The lymph node yield is comparable in patients with different time intervals between radiation therapy and surgery. LNR better discriminates patients in terms of overall survival than ypN categories.

Trial registration number

ClinicalTrials.gov Identifier: NCT01444495, date of registration: September 30, 2011.

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Authors and Affiliations

  1. First Department of General Surgery, Faculty of Medicine, Medical College, Jagiellonian University, 2 Jakubowskiego Street, 30-688, Krakow, Poland

    Radoslaw Pach, Antoni M. Szczepanik, Marek Sierzega & Piotr Richter

  2. Southport & Ormskirk Hospital NHS Trust, Southport, Merseyside, UK

    Michal Daniluk

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  1. Radoslaw Pach
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  2. Antoni M. Szczepanik
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  3. Marek Sierzega
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  4. Michal Daniluk
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  5. Piotr Richter
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Contributions

Study conception and design: RP, PR, AS. Acquisition of data: RP. Analysis and interpretation of data: RP, AS, MS. Drafting of manuscript: RP, AS, MS, PR, MD. Critical revision of manuscript: AS, PR, RP, MD.

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Correspondence to Radoslaw Pach.

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Pach, R., Szczepanik, A.M., Sierzega, M. et al. Prognostic value of lymph node ratio in resectable rectal cancer after preoperative short-course radiotherapy—results from randomized clinical trial. Langenbecks Arch Surg 407, 2969–2980 (2022). https://doi.org/10.1007/s00423-022-02603-8

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  • DOI: https://doi.org/10.1007/s00423-022-02603-8

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