The prognostic impact of the number of lymph nodes retrieved after neoadjuvant chemoradiotherapy with mesorectal excision for rectal cancer

• Published in: Journal of surgical oncology 2009-07, Vol.100 (1), p.1-7
• Main Authors: Kim, Young-Wan, Kim, Nam-Kyu, Min, Byung-Soh, Lee, Kang-Young, Sohn, Seung-Kook, Cho, Chang-Hwan, Kim, Hoguen, Keum, Ki-Chang, Ahn, Jung-Bai
• Format: Article
• Language: English
• Subjects: Adult; Aged; Combined Modality Therapy; Female; Humans; Lymph Node Excision; Male; mesorectal excision; Middle Aged; neoadjuvant chemoradiation; Prognosis; rectal neoplasm; Rectal Neoplasms - mortality; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; retrieved lymph node; Survival Rate
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.21299

Background We aimed to assess factors associated with the number of nodes retrieved and the impact of the number of lymph nodes in rectal cancer patients who underwent neoadjuvant chemoradiation with radical surgery. Methods A total of 258 patients were enrolled. Lymph nodes were retrieved from specimens using a manual dissection technique. Results Of the 258 patients, nine patients had an absence of lymph nodes (ypNx), 150 patients had a node‐negative status (ypN(−)) and 99 patients had node‐positive disease (ypN(+)). An advanced ypT classification (ypT3,4) and larger tumor (>4 cm) were associated with an increased number of nodes retrieved. The pretreatment CEA level (>5 ng/ml) and ypN(+) classification were significant risk factors for cancer specific and recurrence free survival. There was no significant difference of oncological outcomes among ypNx patients and a subset of ypN(−) patients based on the number of nodes retrieved using three cutoff values (1–11, 12–25, and 25–65 nodes). Conclusions In a neoadjuvant setting, ypN(+) disease was an independent risk factor for oncological outcomes. An absence of nodes does not represent an inferior oncological outcome. The number of nodes does not seen to impact survival and recurrence in ypN(−) patients. J. Surg. Oncol. 2009;100:1–7. © 2009 Wiley‐Liss, Inc.