Abstract
Prognosis for patients with locally advanced rectal cancer remains controversial. The purpose of this study was to elucidate possible association between therapeutic effect on lymph nodes (LNs) and patient prognosis. Overall, 149 patients with rectal cancer received preoperative radiotherapy in concomitance with chemotherapy or exclusive radiotherapy before rectal excision. Microscopic examination of formalin-fixed lymph nodes was assessed for therapeutic effect. The establishment of groups combined reaction tissue types of fibrosis, colloid, and necrosis after neoadjuvant treatment was assigned. The average age was 56.38 years, ranged between 22 and 88 years, 53% were female, and 47% were men, with a sex ratio of 1 : 12. In the present study, we noticed that after a median follow-up time of 40.67 months (0–83; SD: 21.1), overall survival was statistically significant depending on age groups. Kaplan–Meier analysis showed significant differences in the rate of patients with an age under 65 years (70.64%) versus those with an age over 85 years (36.5%) (p < 0.001). Also, the OS was statistically significant depending on therapeutic effect groups composed of 0TE (No Therapeutic effect), C+ (presence of only colloidal effect), F+ (presence of only fibrosis tissue), and ME+ (mixture of 2 or 3 types of therapeutic effect) group. Indeed, we observed a significantly higher OS rate in the ME + group (86%) compared with the OS rate of LNs group with no therapeutic effect (57%) (p=0.028). Additionally, there was a significant association between the presence of fibrosis on LNs and an extended delay of more than 8 weeks to neoadjuvant treatment completion and surgery. Our study indicates that the best patient prognosis could be predicted based on tumor presenting a best pathologic effect on lymph nodes, and that delaying surgery for more than 8 weeks to neoadjuvant treatment completion improves therapeutic response on LNs.
Highlights
Rectal cancer (RC) is one of the most common cancers in incidence and mortality in the world [1, 2]
Among the different grouped effects, we found that fibrosis reaction was assessed in 133 cases (91.3%) associated or not with other therapeutic effect types
Colloid changes were found in 66% of cases associated or not with fibrosis and necrosis, while necrosis was associated in all cases with fibrosis and necrosis effect at a rate of 60.7% (Table 1)
Summary
Rectal cancer (RC) is one of the most common cancers in incidence and mortality in the world [1, 2]. RC presents 40% of colorectal cancer and approximately 20% of digestive cancers [3]. E standard treatment for patients with advanced rectal cancer is preoperative chemoradiotherapy or radiotherapy followed by surgery. Is strategy allows to decrease the tumor size as well as to increase the degree of tumor response to neoadjuvant treatment [4]. Dvorak TRG (0, 1, 2, 3, 4) Fibrosis + – – + – + + –.
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