Prognostic Value of Negative Lymph Nodes (NLN) in Rectal Adenocarcinoma

Amir Fikry

doi:10.11648/j.js.20150306.14

Abstract

We studied the impact on prognosis by negative LN (NLN) harvest count on rectal cancer patients, using immunohistochemistry to exclude micrometastasis in nodes negative by hematoxylin and eosin (H & E) stain. A prospective study including 114 patients in Mansoura university hospitals between 2005-2008 aged 18 years or older who were diagnosed as having localized invasive adenocarcinoma rectum with stage I, II & III was conducted. Close follow up done in both surgery department and department of clinical oncology and nuclear medicine for 5 years. We examined patient survival in relation to the negative lymph node count. Our results revealed that the number of negative lymph nodes could affect significantly survival curves where the disease free survival and overall survival were significantly better among the group of patients with more than ten negative LNs (P=0.021 & 0.012 respectively). In conclusion, the negative lymph node count is associated with improved survival of rectal cancer patients.

Highlights

Rectal carcinoma appears to comprise a number of individual disease entities with different physiologic characteristics and probabilities of metastasis [22]
Postoperative follow up included: clinical evaluation, serum CEA, abdominal ultrasound every three months, barium enema every six months, yearly colonoscopy and CT scan .We examined patient survival in relation to the negative lymph node count and the cutoff value was 10 negative LNs (NLNs) [34]
We examined the effect of the negative lymph node count (NLN), as the total lymph node count included positive lymph nodes, which determined tumour stage and affected patient prognosis

Summary

Introduction

Rectal carcinoma appears to comprise a number of individual disease entities with different physiologic characteristics and probabilities of metastasis [22]. Of all the features of the disease examined, in nonmetastatic colorectal cancer, lymph node status is the strongest pathologic predictor of patient outcome [25, 26]. Many studies have correlated improved survival with increasing number of retrieved lymph nodes [7, 36]. Improved outcomes were referred to more accurate staging, which reflected the true node status of the patient, subsequently lead to appropriately utilized chemotherapy. Papers reported significantly increased overall survival and disease free survival as the number of lymph nodes retrieved increased regardless of whether the lymph nodes were positive or negative for metastatic disease [7, 32]. The total number of LNs (TLNs) retrieved encompass both positive (PLNs) and negative LNs (NLNs), so the relationship between TLNs and prognosis is confounded by the prognostic effect of the number of positive LNs [32].

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Results

Conclusion