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Neoadjuvant therapy does not affect lymph node ratio in rectal cancer.

K H Chang1, N P Kelly1, G P Duff1

  • 1Department of Colorectal Surgery, University Hospitals Limerick, Limerick, Ireland.

The Surgeon : Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
|July 8, 2015
PubMed
Summary

Neoadjuvant therapy in rectal cancer reduces lymph node retrieval but does not alter the lymph-node ratio (LNR). This suggests LNR remains a reliable prognostic indicator for patients with AJCC Stage 3 rectal cancer, regardless of neoadjuvant treatment.

Keywords:
Lymph node ratioLymph node yieldNeoadjuvant therapyRectal cancer

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Gastrointestinal Oncology

Background:

  • The lymph-node ratio (LNR) is an emerging prognostic factor in rectal cancer staging.
  • Neoadjuvant therapy is known to reduce the number of lymph nodes retrieved during surgery.
  • Previous studies suggest specific LNR thresholds impact patient survival.

Purpose of the Study:

  • To evaluate the impact of neoadjuvant therapy on lymph node retrieval in rectal cancer.
  • To determine if neoadjuvant therapy affects the prognostic value of LNR.
  • To assess the reliability of LNR as a prognostic indicator after neoadjuvant treatment for rectal cancer.

Main Methods:

  • Retrospective review of consecutive rectal cancer patients undergoing resection (2007-2010).
  • Stratification of LNR into five subgroups based on established thresholds.
  • Comparison of lymph node retrieval, LNR, recurrence rates, disease-free survival (DFS), and overall survival (OS) between neoadjuvant and surgery-alone groups.

Main Results:

  • Neoadjuvant and surgery-alone groups showed comparable demographics and tumor stage.
  • Significantly fewer lymph nodes were retrieved in the neoadjuvant group (p < 0.01).
  • LNR remained statistically similar between groups (p = 0.36), with no significant differences in DFS or OS at various LNR cutoffs for AJCC Stage 3 tumors.

Conclusions:

  • Neoadjuvant therapy does not alter the lymph-node ratio in rectal cancer, despite reducing lymph node retrieval.
  • LNR maintains its prognostic value in rectal cancer patients receiving neoadjuvant therapy.
  • LNR is a potentially reliable prognostic indicator for AJCC Stage 3 rectal cancer patients post-neoadjuvant treatment.