Prognostic Implication of Negative Lymph Node Count in ypN+ Rectal Cancer after Neoadjuvant Chemoradiotherapy and
Yanwu Sun1, Yiyi Zhang1, Zhekun Huang1
1Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China.
Purpose:
This study aimed to investigate the prognostic significance of negative lymph nodes (NLNs) for ypN+ rectal cancer after neoadjuvant chemoradiotherapy (nCRT) and radical surgery and to construct a nomogram predicting disease-free survival (DFS).
Method:
One hundred fifty-eight eligible patients were included. X-tile analysis was performed to determine cutoff values of NLNs. Clinicopathological and survival outcomes were compared. A Cox regression analysis was performed to identify prognostic factors of DFS. A nomogram was constructed and validated internally.
Results:
X-tile analysis identified cutoff values of 4 and 16 in terms of DFS (χ2 = 8.129, p = 0.017). The 3-year DFS rates for low (≤ 4), middle (5-16), and high (≥ 17) NLNs group was 15.2, 55.5, and 73.1%, respectively (P = 0.017). NLN count (NLNs ≥ 17, HR = 0.400, P = 0.022), IMA nodal metastasis (HR = 1.944, P = 0.025), tumor differentiation (poor/anaplastic, HR = 1.805, P = 0.021), and ypT4 stage (HR = 7.787, P = 0.047) were independent prognostic factors of DFS. A predicting nomogram incorporating the four significant predictors was developed with a C-index of 0.64.
Conclusion:
NLN count was an independent prognostic factor of DFS in patients with ypN+ rectal cancer following nCRT. A nomogram incorporating NLN count, IMA nodal metastasis, tumor differentiation, and ypT stage could stratify rectal cancer patients with different DFS and might be helpful during clinical decision-making.
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