Abstract
According to the American Joint Committee on Cancer, at least 12 lymph nodes are required to accurately stage locally advanced rectal cancer (LARC). Neoadjuvant chemoradiation therapy (NACRT) reduces the number of lymph nodes retrieved during surgery. In this study, we evaluated the effect of NACRT on lymph node retrieval and prognosis in patients with LARC. We performed an observational study of 142 patients with LARC. Although our analysis was retrospective, data were collected prospectively. Half the patients were treated with NACRT and total mesorectal excision (TME) and the other half underwent TME only. The number of lymph nodes retrieved and the number of metastatic lymph nodes were significantly reduced in the NACRT group (P > 0.001). In the univariate and multivariate analyses, only NACRT and patient age were significantly associated with reduced lymph node retrieval. The number of metastatic lymph nodes and the lymph node ratio (LNR) both had a significant effect on prognosis when the patient population was examined as a whole (P = 0.003 and P = 0.001, respectively). However, the LNR was the only significant, independent prognostic factor in both treatment groups (P = 0.007 for the NACRT group; P = 0.04 for the no-NACRT group). NACRT improves patient prognosis only when the number of metastatic lymph nodes is reduced. The number of metastatic lymph nodes and the LNR are important prognostic factors. Lymph node retrieval remains an indispensable tool for staging and prognostic assessment of patients with rectal carcinoma treated with NACRT.
Highlights
In Western countries, colorectal carcinoma is one of the main causes of cancer-related death
After total mesorectal excision (TME) in the no-Neoadjuvant chemoradiation therapy (NACRT) group, 46.5% patients were classified as having stage II cancer and 53.5% with stage III cancer
80.3% of patients in the NACRT group did not have metastatic lymph nodes, whereas the proportion was much lower in the no-NACRT group (46.5%)
Summary
In Western countries, colorectal carcinoma is one of the main causes of cancer-related death. 75% of patients with colorectal cancer undergo radical treatment [1]. Neoadjuvant chemoradiation therapy (NACRT) followed by total mesorectal excision (TME) has become the treatment of choice for patients with stage II–III locally advanced rectal cancer (LARC) [2,3,4,5,6]. 2 U.O.C. General Surgery, ASP Siracusa, Contrada Colle Roggio, Lentini, Sicily, Italy chemoradiation was safer and more effective than TME with no prior treatment in patients with LARC [6,7,8]. NACRT improves the local control of the malignancy and overall survival, in patients with a complete response to treatment [9, 10]. Inaccurate pre-operative staging can preclude the possibility for some patients to receive NACRT, those in under-represented ethnic groups, those who present to a lowvolume center, and those of low socioeconomic status [6]
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