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Examined lymph node numbers influence prognosis in rectal cancer treated with neoadjuvant therapy.

Liyu Zhu1,2, Lin Wang3, Zhidong Gao1,2

  • 1Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing 100044, China.

Cancer Pathogenesis and Therapy
|February 8, 2024
PubMed
Summary

The total number of lymph nodes examined (TLNe) and negative lymph nodes examined (NLNe) impact rectal cancer staging and prognosis after neoadjuvant therapy. Examining 14-16 lymph nodes is crucial for accurate staging and predicting outcomes.

Keywords:
Lymph nodes examinedNeoadjuvant therapyPrognosisRectal cancerStaging accuracy

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Area of Science:

  • Oncology
  • Surgical Pathology
  • Cancer Prognostics

Background:

  • Insufficient lymph node examination (LNe) is common in rectal cancer (RC) patients receiving neoadjuvant therapy.
  • The prognostic significance of LNe in this context remains debated.
  • This study investigates the influence of LNe on staging and prognosis in neoadjuvant-treated RC.

Purpose of the Study:

  • To determine if the number of lymph nodes examined (LNe) affects staging accuracy in rectal cancer (RC) patients.
  • To evaluate the prognostic value of LNe in RC patients undergoing neoadjuvant therapy.
  • To identify optimal cut-off values for LNe to improve prognostic prediction.

Main Methods:

  • Retrospective analysis of data from seven Chinese hospital databases (July 2002 - May 2018).
  • Binary logistic regression for lymph node metastasis prediction; X-tile software for LNe cut-off determination.
  • Log-rank test and Cox regression for survival outcomes and risk factor analysis.

Main Results:

  • Total lymph nodes examined (TLNe) between 14-16 showed the highest odds ratio for lymph node metastasis (OR=3.379, P=0.003).
  • Negative lymph nodes examined (NLNe) ≤6 was an independent risk factor for 3- and 5-year overall survival (OS).
  • Higher OS was observed with TLNe >10 in ypN+ patients and TLNe >19 in ypN0M0 patients.

Conclusions:

  • The total number of lymph nodes examined (TLNe) and negative lymph nodes examined (NLNe) significantly influence staging accuracy.
  • LNe possesses prognostic value in rectal cancer patients treated with neoadjuvant therapy.
  • Specific TLNe thresholds can aid in refining prognostic assessment for rectal cancer patients.