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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