Prognostic implications of the distribution of lymph node metastases in rectal cancer after neoadjuvant chemoradiotherapy Journal Article


Authors: Leibold, T.; Shia, J.; Ruo, L.; Minsky, B. D.; Akhurst, T.; Gollub, M. J.; Ginsberg, M. S.; Larson, S.; Riedel, E.; Wong, W. D.; Guillem, J. G.
Article Title: Prognostic implications of the distribution of lymph node metastases in rectal cancer after neoadjuvant chemoradiotherapy
Abstract: Purpose: After preoperative chemoradiotherapy of rectal cancer, the number of retrievable and metastatic lymph nodes is decreased. The current TNM classification is based on number and not location of lymph node metastases and may understage disease after chemoradiotherapy. The aim of this study was to examine the prognostic significance of location of involved lymph nodes in rectal cancer patients after preoperative chemoradiotherapy. Patients and Methods: We prospectively examined whole-mount specimens from 121 patients with uT3-4 and/or N+ rectal cancer who received preoperative chemoradiotherapy followed by resection. Location of involved lymph nodes was compared with median number of lymph nodes involved as well as presence of distant metastasis at presentation. Results: Lymph node metastases were detected in 37 patients (31%). Thirteen patients with lymph node involvement along major supplying vessels (proximal lymph node metastases) had a significantly higher rate of distant metastatic disease at time of surgery than patients without proximal lymph node involvement (P < .001); median number of lymph nodes involved was two for patients with proximal lymph node metastases and 1.5 for patients with mesorectal lymph node involvement alone. Conclusion: Our data suggest that, after preoperative chemoradiotherapy, proximal lymph node involvement is associated with a high incidence of metastatic disease at time of surgery. Because the median number of involved lymph nodes is low after preoperative chemoradiotherapy, the TNM staging system may not provide an accurate assessment of metastatic disease. Therefore, the ypTNM staging system should incorporate distribution as well as number of lymph node metastases after preoperative chemoradiotherapy for rectal cancer. © 2008 by American Society of Clinical Oncology.
Keywords: adult; cancer chemotherapy; controlled study; aged; middle aged; cancer surgery; major clinical study; fluorouracil; monotherapy; adjuvant therapy; cancer radiotherapy; comparative study; preoperative care; chemotherapy, adjuvant; neoadjuvant therapy; radiotherapy, adjuvant; cancer staging; positron emission tomography; lymph node metastasis; lymph nodes; lymphatic metastasis; neoplasm staging; prospective study; lymph node excision; prospective studies; lymphadenectomy; adenocarcinoma; reproducibility; reproducibility of results; computer assisted tomography; multiple cycle treatment; tomography, x-ray computed; continuous infusion; drug effect; pathology; cetuximab; radiation exposure; folinic acid; adjuvant chemotherapy; lymph node; fluorodeoxyglucose f 18; positron-emission tomography; prediction and forecasting; predictive value of tests; external beam radiotherapy; rectal neoplasms; rectum cancer; rectum tumor; endoscopic echography; endosonography
Journal Title: Journal of Clinical Oncology
Volume: 26
Issue: 13
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2008-05-01
Start Page: 2106
End Page: 2111
Language: English
DOI: 10.1200/jco.2007.12.7704
PUBMED: 18362367
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 22" - "Export Date: 17 November 2011" - "CODEN: JCOND" - "Source: Scopus"
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MSK Authors
  1. Bruce Minsky
    262 Minsky
  2. Marc J Gollub
    109 Gollub
  3. Michelle S Ginsberg
    158 Ginsberg
  4. Leyo Ruo
    31 Ruo
  5. Jose Guillem
    371 Guillem
  6. Tobias Leibold
    11 Leibold
  7. Jinru Shia
    459 Shia
  8. Timothy J Akhurst
    134 Akhurst
  9. Steven M Larson
    774 Larson
  10. Douglas W Wong
    173 Wong
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