Lymph node regression after neoadjuvant chemoradiotherapy in rectal cancer

Histopathology, vol. 84, pp. 935–946

Abstract

AIMS: Lymph node metastases (LNM) are one of the most important prognostic indicators in solid tumours and a major component of cancer staging. Neoadjuvant therapy might influence nodal status by induction of regression. Our aim is to determine the prevalence and role of regression of LNM on outcomes in patients with rectal cancer. METHODS AND RESULTS: Four independent study populations of rectal cancer patients treated with similar regimens of chemoradiotherapy were pooled together to obtain a total cohort of 469 patients. Post-treatment nodal status (ypN) and signs of tumour regression (Reg) were incorporated to form three-tiered (ypN- Reg+, ypN- Reg- and ypN+) and four-tiered (ypN- Reg+, ypN- Reg-, ypN+ Reg+ and ypN+ Reg-) classifications. In our cohort, 31% of patients presented with ypN+ rectal cancer. As expected, we found significantly worse overall survival (OS) in ypN+ patients compared to ypN- patients (P = 0.002). The percentage of ypN- patients with lymph nodes with complete regression was 20% in our cohort. While node-negative patients with and without regression had similar OS (P = 0.09), disease-free survival (DFS) was significantly better in node-negative patients with regression (P = 0.009). CONCLUSIONS: Regression in lymph nodes is frequent, and node-negative patients with evidence of lymph node regression have better DFS compared to node-negative patients without such evidence.

Authors 12

1. Sonay Kuş Öztürk

   Radboud University Nijmegen · Radboud University Medical Center

   Affiliation as printed

   Department of Pathology Radboud University Medical Centre Nijmegen the Netherlands

   Department of Pathology, Radboud University Medical Centre, Nijmegen, the Netherlands

2. Cristina Graham Martínez

   Radboud University Nijmegen · Radboud University Medical Center

   Affiliation as printed

   Department of Pathology Radboud University Medical Centre Nijmegen the Netherlands

   Department of Pathology, Radboud University Medical Centre, Nijmegen, the Netherlands

3. David M Mens

   Erasmus MC

   Affiliation as printed

   Department of Surgical Oncology Erasmus Medical Centre Rotterdam the Netherlands

   Department of Surgical Oncology, Erasmus Medical Centre, Rotterdam, the Netherlands

4. Cornelis Kees Verhoef

   Erasmus MC

   Affiliation as printed

   Department of Surgical Oncology Erasmus Medical Centre Rotterdam the Netherlands

   Department of Surgical Oncology, Erasmus Medical Centre, Rotterdam, the Netherlands

5. Miriam Tosetto

   St. Vincent's University Hospital

   Affiliation as printed

   Department of Pathology St Vincent's University Hospital Dublin Ireland

   Department of Pathology, St Vincent's University Hospital, Dublin, Ireland

6. Kieran D. Sheahan

   St. Vincent's University Hospital

   Affiliation as printed

   Department of Pathology St Vincent's University Hospital Dublin Ireland

   Department of Pathology, St Vincent's University Hospital, Dublin, Ireland

7. Johannes H.W. de Wilt

   Radboud University Nijmegen · Radboud University Medical Center

   Affiliation as printed

   Department of Surgical Oncology Radboud University Medical Centre Nijmegen the Netherlands

   Department of Surgical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands

8. Geke A.P. Hospers

   University Medical Center Groningen

   Affiliation as printed

   Department of Oncology University Medical Centre Groningen Groningen the Netherlands

   Department of Oncology, University Medical Centre Groningen, Groningen, the Netherlands

9. Cornelis J.�H. van de Velde Aachen Department of Surgery Leiden University Medical Centre Leiden The Netherlands Department of Surgery, Leiden University Medical Centre

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Surgery Leiden University Medical Centre Leiden the Netherlands

   Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands

10. Corrie A.M. Marijnen Aachen Department of Radiotherapy Leiden University Medical Centre Leiden The Netherlands Department of Radiotherapy, Leiden University Medical Centre

    Leiden University · Leiden University Medical Center

    Affiliation as printed

    Department of Radiotherapy Leiden University Medical Centre Leiden the Netherlands

    Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands

11. Rachel S. van der Post

    Radboud University Nijmegen · Radboud University Medical Center

    Affiliation as printed

    Department of Pathology Radboud University Medical Centre Nijmegen the Netherlands

    Department of Pathology, Radboud University Medical Centre, Nijmegen, the Netherlands

12. Irıs D. Nagtegaal corresponding

    Radboud University Nijmegen · Radboud University Medical Center

    Affiliation as printed

    Department of Pathology Radboud University Medical Centre Nijmegen the Netherlands

    Department of Pathology, Radboud University Medical Centre, Nijmegen, the Netherlands