Lymph nodes regression grade is a predictive marker for rectal cancer after neoadjuvant therapy and radical surgery.

Jun Li,Jie Yin,Sai Liu,Bo Lv,Hao Liu,Ci Li,Junjie Hu,Feng Du,Jiatian Yuan,Xiangke Niu,Shasha Xing

doi:10.18632/oncotarget.7703

Abstract

Neoadjuvant therapy (NT) for rectal cancer (RC) reduces primary tumors and involved lymph nodes. While a prognostic value of tumor regression grade (TRG) has been identified, involved lymph node regression grade (LRG) has not been systematically evaluated. Here, we evaluated the association of LRG with oncologic outcomes of RC patients after NT followed by radical surgery. 347 patients with locally advanced RC who received NT and then underwent radical surgery were retrospectively recruited between 2004 and 2011. Response to NT was evaluated by a 3-tier LRG and TRG based on the ratio of residual tumor to fibrosis. LRG was assessed in all patients (LRG 0, 170 patients [49.0%]; LRG 1, 100 patients [28.8%]; and LRG 2, 77 patients [22.2%]). LRG correlated with 5-year distant metastasis and 5-year disease free survival (p=0.029 and 0.023, respectively). LRG also correlated with TRG (p=0.017). We conclude that the LRG system may be an independent predictive factor of long-term oncologic outcomes of rectal cancer patients after NT and radical surgery.

Highlights

Neoadjuvant therapy (NT) in rectal cancer (RC) downstages primary tumors and reduces local recurrence in locally advanced rectal cancer [1, 2]
Patient characteristics and association of lymph node regression grade (LRG) with clinicopathologic factors patients with locally advanced rectal cancer who received radical surgery in 6-8weeks after NT were identified in this retrospective study
In 2002, Bouzorene et al [9] retrospectively reviewed the resection specimens from 102 patients with locally advanced rectal cancer after preoperative radiotherapy and indicated that tumor regression was a predictive factor for survival

Summary

Introduction

Neoadjuvant therapy (NT) in rectal cancer (RC) downstages primary tumors and reduces local recurrence in locally advanced rectal cancer [1, 2]. Various grading systems, including the Manard, Dowrak, Dowark/ Rodel, AJCC and MSKCC have been proposed. All of these use the percentage of tumor cells relative to fibrosis. TRG scores do not account for the involvement of lymph nodes, which is an important prognostic parameter [3]. While Caricato et al [7] demonstrated that LRG correlated with TRG in primary tumors, but they did not examine the impact of LRG on oncologic outcomes. We evaluated the impact of LRG on oncologic outcomes including local recurrence (LR), distant metastasis (DM), and 5-year disease-free survival (DFS), and the LRG correlation with TRG in primary RC tumors

Methods

Results

Conclusion