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Lymph Node Positivity in T1/T2 Rectal Cancer: a Word of Caution in an Era of Increased Incidence and Changing Biology for Rectal Cancer

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The evaluation of lymph nodes in rectal cancer dictates treatment. The goals of this study are to characterize the contemporary rate of lymph node metastasis in early stage rectal cancer and to re-investigate histologic factors that predict positive lymph nodes.

Materials and Methods

Using the National Cancer Database, we identified patients with clinical stage I rectal adenocarcinoma. Multivariable logistic regression was used to determine risk factors for lymph node positivity.

Results

12.2% of patients with T1 tumors and 18.0% of patients with T2 tumors had positive lymph nodes. For T1 tumors, positive lymph nodes were present in 9.3% with neither poor differentiation nor lymphovascular invasion (LVI), 17.3% with poor differentiation alone, 34.7% with LVI alone, and 45.0% with both poor differentiation and LVI. For T2 tumors, positive lymph nodes were present in 11.7% with neither poor differentiation nor LVI, 25.3% with poor differentiation alone, 47.3% with LVI alone, and 41.5% with both poor differentiation and LVI. LVI was an independent predictor of positive lymph nodes (OR;4.75,95%CI;3.17–7.11,p < 0.001) for T1 and (OR;6.20,95%CI;4.53–8.51,p < 0.001) T2 tumors.

Conclusions

T1/T2 tumors have higher rates of positive lymph nodes when poor differentiation and LVI are present. These results should be taken into consideration prior to surgical treatment.

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References

  1. American Cancer Society. Key Statistics for Colorectal Cancer. https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html. Accessed: June 30, 2018.

  2. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Rectal Cancer Version 2.2018; National Comprehensive Cancer Network.

  3. Ricciardi R., Madoff R., Rothenberger D., Baxter N. Population-based analyses of lymph node metastases in colorectal cancer. Clin Gastroenterol and Hepato. 2006;4:1522–1527.

    Article  Google Scholar 

  4. Bentrem DJ, Okabe S, Wong D, et al. T1 adenocarcinoma of the rectum: transanal excision or radical surgery? Ann Surg. 2005;242(4):472–479.

    Article  Google Scholar 

  5. Nash GM, Weiser MR, Guillem JG, et al. Long-term survival after transanal excision of T1 rectal cancer. Dis Colon Rectum. 2009;52(4):577–582.

    Article  Google Scholar 

  6. Meyer JE, Cohen SJ, Ruth KJ, Sigurdson ER, Hall MJ. Young age increases risk for lymph node positivity in early-stage rectal cancer. J Natl Cancer Inst. 2016;108(1):djv284.

    Article  Google Scholar 

  7. Kobayashi H, Mochizuki H, Kato T, et al. Is total mesorectal excision always necessary for T1–T2 lower rectal cancer? Ann Surg Oncol. 2010;17(4):973–980.

    Article  Google Scholar 

  8. Glasgow SC, Bleier JIS, Burgart LJ, et al. Meta-analysis of histopathological features of primary colorectal cancers that predict lymph node metastases. J Gastrointest Surg. 2012;16:1019–1028.

    Article  Google Scholar 

  9. Saclarides TJ, Bhattacharyya AK, Britton-Kuzel C, Szeluga D, Economou SG. Predicting lymph node metastases in rectal cancer. Dis Colon Rectum. 1994;37(1):52–7.

    Article  CAS  Google Scholar 

  10. Okabe S, Shia J, Nash G, et al. Lymph node metastasis in T1 adenocarcinoma of the colon and rectum. J Gastrointest Surg. 2004;1(8):1032–1040.

    Article  Google Scholar 

  11. Muthusamy VR, Chang KJ. Optimal methods for staging rectal cancer. Clin Cancer Res. 2007;13(22):6877–6884.

    Article  Google Scholar 

  12. Gröne J, Loch FN, Taupitz, M, Schmid C, Kreis ME. Accuracy of various lymph node staging criteria in rectal cancer with magnetic resonance imaging. J Gastrointest Surg, 2018;22(1):146–153.

    Article  Google Scholar 

  13. Brown G. "Staging rectal cancer: endoscopic ultrasound and pelvic MRI." Cancer Imaging 2008;8:S43.

    Article  Google Scholar 

  14. Monig SP, Baldus SE, Zirbes TK, et al. Lymph node size and metastatic infiltration in colon cancer. Ann Surg Oncol 1999;6:579–581.

    Article  CAS  Google Scholar 

  15. Garcia-Aguilar J, Renfro LA, Chow OS, et al. Organ preservation for clinical T2N0 distal rectal cancer using neoadjuvant chemoradiotherapy and local excision (ACOSOG Z6041): results of an open-label, single-arm, multi-institutional phase 2 trial. Lancet Oncol 2015;16(15):1537–1546.

    Article  Google Scholar 

  16. You NY, Baxter NN, Stewart A, Nelson H. Is the increasing rate of local excision for stage 1 rectal cancer in the United States justified? A nationwide cohort study from the national cancer database. Ann Surg. 2007;245(5):726–733.

    Article  Google Scholar 

  17. Greenberg JA, Shibata D, Herndon JE, et al. Local excision of distal rectal cancer: An update of cancer and leukemia group B 8984. Dis Colon Rectum 2008;51(8):1185–1194.

    Article  Google Scholar 

  18. Winchster DP, Stewart AK, Phillips JL, Ward EE. The national cancer database: past, present, and future. Ann Surg Oncol 2010;17(1):4–7.

    Article  Google Scholar 

  19. Blumberg D, Paty PB, Guillem JG, et al. All patients with small intramural rectal cancers are at risk for lymph node metastasis. Dis Colon Rectum. 1999;42(7):881–885.

    Article  CAS  Google Scholar 

  20. Tjandra JJ, Kilkenny JW, Buie WD, et al. Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum. 2005;48:411–423.

    Article  Google Scholar 

  21. National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in Oncology: Rectal Cancer—Version 4.2013. Fort Washington, PA, National Comprehensive Cancer Network, 2012.

  22. Stitzenberg KB, Sanoff HK, Penn DC, Meyers MO, Tepper JE. Practice patterns and long-term survival for early-stage rectal cancer. J Clin Oncol. 2013;31:4276–4282.

    Article  Google Scholar 

  23. Doornebosch PG, Ferenschild FT, de Wilt JH, Dawson I, Tetteroo GW, de Graaf EJ. Treatment of recurrence after transanal endoscopic microsurgery (TEM) for T1 rectal cancer. Dis Colon Rectum. 2010;53(9):1234–1239.

    Article  Google Scholar 

  24. Paty PB, Nash GM, Baron P, et al. Long-term results of local excision for rectal cancer. Ann Surg. 2002;236(4):522–530.

    Article  Google Scholar 

  25. Hahnloser D, Wolff BG, Larson DW, Ping J, Nivatvongs S. Immediate radical resection after local excision of rectal cancer: an oncologic compromise? Dis Colon Rectum. 2005;48(3):429–437.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Division of Colorectal Surgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Adam C. Fields, Pamela Lu, Frances Hu, Sameer Hirji, Jennifer Irani, Ronald Bleday, Nelya Melnitchouk & Joel E. Goldberg

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  1. Adam C. Fields
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  2. Pamela Lu
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  3. Frances Hu
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  4. Sameer Hirji
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Contributions

All authors had substantial contributions to design of work, drafted work, made final approval, and agreed to be accountable for all aspects of the work.

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Correspondence to Adam C. Fields or Joel E. Goldberg.

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The authors declare that they have no conflict of interest.

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The study was reviewed and approved by the Institutional Review Board.

This work was presented as a podium presentation at the American College of Surgeons Clinical Congress, Oct 21-25 2018, Boston, Massachusetts.

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Fields, A.C., Lu, P., Hu, F. et al. Lymph Node Positivity in T1/T2 Rectal Cancer: a Word of Caution in an Era of Increased Incidence and Changing Biology for Rectal Cancer. J Gastrointest Surg 25, 1029–1035 (2021). https://doi.org/10.1007/s11605-020-04580-z

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  • DOI: https://doi.org/10.1007/s11605-020-04580-z

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