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Journal of Gastrointestinal Surgery
Erschienen in:

26.03.2020 | Original Article

Lymph Node Regression to Neoadjuvant Chemoradiotherapy in Patients with Locally Advanced Rectal Cancer: Prognostic Implication and a Predictive Model

verfasst von: Yanwu Sun, Xuejing Wu, Huiming Lin, Xingrong Lu, Ying Huang, Pan Chi

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 4/2021

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Abstract

Aim

Currently, few studies have focused on the prognostic impact of lymph node regression to neoadjuvant chemoradiotherapy (NCRT) in rectal cancer. This study aimed to explore the prognostic impact of lymph node regression grade (LRG) in patients with locally advanced rectal cancer (LARC) following NCRT and radical surgery and develop a predictive nomogram for disease-free survival (DFS).

Methods

LARC patients undergoing NCRT and radical surgery between 2013 and 2014 were enrolled and divided into LRG low (≤ 2), middle (3–9), and high (≥ 10) groups. Clinicopathological characteristics and survival outcomes were compared. Predictors for DFS were identified by Cox regression analysis, and a nomogram was constructed.

Results

A total of 257 LARC patients were eligible, including LRG low (n = 149), middle (n = 59), and high (n = 49) groups. Higher LRG score was associated with higher TRG, more advanced ypT and ypN stages, and poorer OS and DFS (all P < 0.001). Cox regression analysis demonstrated that tumor differentiation (poor and anaplastic, HR = 2.048, P = 0.048), ypTNM stage (HR = 2.389, P = 0.015), and LRG-sum (HR = 1.020, P = 0.029) were independent prognostic determinants for DFS after NCRT. A nomogram for DFS was developed with a C-index of 0.68 (95%CI 0.64–0.72).

Conclusion

LRG is an important prognostic indicator for DFS in LARC patients after NCRT. A predictive nomogram based on LRG was developed to guide more tailored adjuvant treatment and surveillance.
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Literatur
1.
van Gijn W, Marijnen CA, Nagtegaal ID, Kranenbarg EM, Putter H, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van de Velde CJ. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol. 2011; 12: 575–82.CrossRef
2.
Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, Becker H, Raab H, Villanueva M, Witzigmann H, Wittekind C, Beissbarth T, Rödel C. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol. 2012; 30: 1926–33.CrossRef
3.
Kong J, Guerra G, Warrier S, Lynch A, Michael M, Ngan S, Phillips W, Ramsay G, Heriot A. Prognostic value of tumour regression grade in locally advanced rectal cancer: a systematic review and meta-analysis. Colorectal Dis. 2018; 20: 574–85.CrossRef
4.
Mandard A, Dalibard F, Mandard J, Marnay J, Henry-Amar M, Petiot J, Roussel A, Jacob J, Segol P, Samama G. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer. 1994; 73: 2680–6.CrossRef
5.
Dworak O, Keilholz L, Hoffmann A. Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Colorectal Dis. 1997; 12: 19–23.CrossRef
6.
Wheeler J, Warren B, Mortensen N, Ekanyaka N, Kulacoglu H, Jones A, George B, Kettlewell M. Quantification of histologic regression of rectal cancer after irradiation: a proposal for a modified staging system. Dis Colon Rectum. 2002; 45: 1051–6.CrossRef
7.
Rödel C, Martus P, Papadoupolos T, Füzesi L, Klimpfinger M, Fietkau R, Liersch T, Hohenberger W, Raab R, Sauer R, Wittekind C. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol. 2005; 23: 8688–96.CrossRef
8.
Ryan R, Gibbons D, Hyland J, Treanor D, White A, Mulcahy H, O'Donoghue D, Moriarty M, Fennelly D, Sheahan K. Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Histopathology. 2005; 47: 141–6.CrossRef
9.
Fokas E, Liersch T, Fietkau R, Hohenberger W, Beissbarth T, Hess C, Becker H, Ghadimi M, Mrak K, Merkel S, Raab H, Sauer R, Wittekind C, Rödel C. Tumor regression grading after preoperative chemoradiotherapy for locally advanced rectal carcinoma revisited: updated results of the CAO/ARO/AIO-94 trial. J Clin Oncol. 2014; 32: 1554–62.CrossRef
10.
Mirbagheri N, Kumar B, Deb S, Poh B, Dark J, Leow C, Teoh W. Lymph node status as a prognostic indicator after preoperative neoadjuvant chemoradiotherapy of rectal cancer. Colorectal Dis. 2014; 16: O339–46.CrossRef
11.
Okada K, Sadahiro S, Suzuki T, Tanaka A, Saito G, Kamijo A, Akiba T, Kawada S. Effects of chemoradiotherapy on lymph nodes in patients with rectal adenocarcinoma: evaluation of numbers and sizes of retrieved lymph nodes inside and outside the radiation field. Anticancer Res. 2014; 34: 4195–200.PubMed
12.
Caricato M, Ausania F, De Dominicis E, Vincenzi B, Rabitti C, Tonini G, Cellini F, Coppola R. Tumor regression in mesorectal lymphnodes after neoadjuvant chemoradiation for rectal cancer. Eur J Surg Oncol. 2007; 33: 724–8.CrossRef
13.
Fernández-Aceñero M, Granja M, Sastre J, García-Paredes B, Estrada L. Prognostic significance of tumor regression in lymph nodes after neoadjuvant therapy for rectal carcinoma. Virchows Arch. 2016; 468: 425–30.CrossRef
14.
Li J, Yuan J, Liu H, Yin J, Liu S, Du F, Hu J, Li C, Niu X, Lv B, Xing S. Lymph nodes regression grade is a predictive marker for rectal cancer after neoadjuvant therapy and radical surgery. Oncotarget. 2016; 7: 16975–84.CrossRef
15.
Ogston KN, Miller ID, Payne S, Hutcheon AW, Sarkar TK, Smith I, Schofield A, Heys SD. A new histological grading system to assess response of breast cancers to primary chemotherapy: prognostic significance and survival. Breast. 2003; 12: 320–7.CrossRef
16.
Philippron A, Bollschweiler E, Kunikata A, Plum P, Schmidt C, Favi F, Drebber U, Hölscher A. Prognostic relevance of lymph node regression after neoadjuvant chemoradiation for esophageal cancer. Semin Thorac Cardiovasc Surg. 2016; 28: 549–58.CrossRef
17.
Davies A, Myoteri D, Zylstra J, Baker C, Wulaningsih W, Van Hemelrijck M, Maisey N, Allum W, Smyth E, Gossage J, Lagergren J, Cunningham D, Green M, Guy'S And St Thomas' Oesophago-Gastric Research Group And PROGRESS Study G. Lymph node regression and survival following neoadjuvant chemotherapy in oesophageal adenocarcinoma. Br J Surg. 2018; 105: 1639–49.CrossRef
18.
Camp R, Dolled-Filhart M, Rimm D. X-tile: a new bio-informatics tool for biomarker assessment and outcome-based cut-point optimization. Clin Cancer Res. 2004; 10: 7252–9.CrossRef
19.
Sun Y, Zhang Y, Huang Z, Chi P. Prognostic implication of negative lymph node count in ypN+ rectal cancer after neoadjuvant chemoradiotherapy and construction of a prediction nomogram. J Gastrointest Surg. 2019; 23: 1006–14.CrossRef
20.
Sun Y, Chi P, Lin H, Lu X, Huang Y, Xu Z, Huang S, Wang X. Inferior mesenteric artery lymph node metastasis in rectal cancer treated with neoadjuvant chemoradiotherapy: Incidence, prediction and prognostic impact. Eur J Surg Oncol. 2017; 43: 85–91.CrossRef
21.
Beppu N, Matsubara N, Noda M, Yamano T, Kakuno A, Doi H, Kamikonya N, Yamanaka N, Yanagi H, Tomita N. Pathologic evaluation of the response of mesorectal positive nodes to preoperative chemoradiotherapy in patients with rectal cancer. Surgery. 2015; 157: 743–51.CrossRef
22.
Choi JP, Kim SJ, Park IJ, Hong SM, Lee JL, Yoon YS, Kim CW, Lim SB, Lee JB, Yu CS, Kim JC. Is the pathological regression level of metastatic lymph nodes associated with oncologic outcomes following preoperative chemoradiotherapy in rectal cancer? Oncotarget. 2017; 8: 10375–84.CrossRef
23.
Beppu N, Kakuno A, Doi H, Kamikonya N, Matsubara N, Tomita N, Yanagi H, Yamanaka N. The impact of the radiation-induced regression of positive nodes on survival in patients with rectal cancer treated with chemoradiotherapy. Surgery. 2017; 161: 422–32.CrossRef
24.
Lee HG, Kim SJ, Park IJ, Hong SM, Lim SB, Lee JB, Yu CS, Kim JC. Effect of responsiveness of lymph nodes to preoperative chemoradiotherapy in patients with rectal cancer on prognosis after radical resection. Clin Colorectal Cancer. 2019; 18: e191–9.CrossRef
25.
Losi L, Luppi G, Gavioli M, Iachetta F, Bertolini F, D'Amico R, Jovic G, Bertoni F, Falchi A, Conte P. Prognostic value of Dworak grade of regression (GR) in patients with rectal carcinoma treated with preoperative radiochemotherapy. Int J Colorectal Dis. 2006; 21: 645–51.CrossRef
26.
Mignanelli ED, de Campos-Lobato LF, Stocchi L, Lavery IC, Dietz DW. Downstaging after chemoradiotherapy for locally advanced rectal cancer: is there more (tumor) than meets the eye? Dis Colon Rectum. 2010; 53: 251–6.CrossRef
27.
Tominaga T, Akiyoshi T, Yamamoto N, Oba K, Nagasaki T, Yamaguchi T, Konishi T, Fukunaga Y, Ueno M. Prognostic value of metastatic lymph node regression grade after neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer. Surgery. 2019; 166: 1061–7.CrossRef
28.
Lim SB, Yu CS, Hong YS, Kim TW, Park JH, Kim JH, Kim JC. Failure patterns correlate with the tumor response after preoperative chemoradiotherapy for locally advanced rectal cancer. J Surg Oncol. 2012; 106: 667–73.CrossRef
29.
Bujko K, Michalski W, Kepka L, Nowacki MP, Nasierowska-Guttmejer A, Tokar P, Dymecki D, Pawlak M, Lesniak T, Richter P, Wojnar A, Chmielik E. Association between pathologic response in metastatic lymph nodes after preoperative chemoradiotherapy and risk of distant metastases in rectal cancer: an analysis of outcomes in a randomized trial. Int J Radiat Oncol Biol Phys. 2007; 67: 369–77.CrossRef
30.
Sargent DJ, Wieand HS, Haller DG, Gray R, Benedetti JK, Buyse M, Labianca R, Seitz JF, O'Callaghan CJ, Francini G, Grothey A, O'Connell M, Catalano PJ, Blanke CD, Kerr D, Green E, Wolmark N, Andre T, Goldberg RM, De Gramont A. Disease-free survival versus overall survival as a primary end point for adjuvant colon cancer studies: individual patient data from 20,898 patients on 18 randomized trials. J Clin Oncol. 2005; 23: 8664–70.CrossRef
31.
Sun Y, Lin H, Lu X, Huang Y, Xu Z, Huang S, Wang X, Chi P. A nomogram to predict distant metastasis after neoadjuvant chemoradiotherapy and radical surgery in patients with locally advanced rectal cancer. J Surg Oncol. 2017; 115: 462–9.CrossRef
Metadaten
Titel
Lymph Node Regression to Neoadjuvant Chemoradiotherapy in Patients with Locally Advanced Rectal Cancer: Prognostic Implication and a Predictive Model
verfasst von
Yanwu Sun
Xuejing Wu
Huiming Lin
Xingrong Lu
Ying Huang
Pan Chi
Publikationsdatum
26.03.2020
Verlag
Springer US
Erschienen in
Journal of Gastrointestinal Surgery / Ausgabe 4/2021
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-020-04566-x

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