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  • Lymph node number, surface area and lymph node ratio are important prognostic indicators in neoadjuvant chemoradiotherapy treated rectal cancer

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Original research
Lymph node number, surface area and lymph node ratio are important prognostic indicators in neoadjuvant chemoradiotherapy treated rectal cancer
  1. Francesca Pitto1,
  2. Gabriele Zoppoli2,3,
  3. Stefano Scabini4,
  4. Emanuele Romairone3,
  5. Roberto Fiocca3,5,
  6. Alberto Ballestrero2,3,
  7. Marco Sparavigna6,
  8. Lara Malaspina5,
  9. Luca Valle5,
  10. Federica Grillo3,5,
  11. Luca Mastracci3,5
  1. 1 Anatomic Pathology, Ospedale Policlinico San Martino Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia, Genova, Italy
  2. 2 Department of Internal Medicine, University of Genoa, Genova, Italy
  3. 3 Department of Surgery, Ospedale Policlinico San Martino Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia, Genova, Italy
  4. 4 Oncological Surgery, Ospedale Policlinico San Martino Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia, Genova, Italy
  5. 5 Unit of Anatomic Pathology, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genova, Italy
  6. 6 Surgery, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genova, Italy
  1. Correspondence to Dr Federica Grillo, Unit of Anatomic Pathology, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genova, Liguria 16132, Italy; federica.grillo{at}unige.it

Abstract

Aims Neoadjuvant chemoradiotherapy (neoCRT) is recommended for locally advanced rectal cancer (RC), however, this often makes lymph node (LN) search trying. The aim of this study was to evaluate, in a large retrospective, monocentric, series of post-neoCRT-RC patients, the importance of LN number, ratio and surface area in predicting metastases, overall survival (OS) and disease free survival (DFS).

Methods 104 patients with RC underwent total mesorectal excision, after standard neoCRT. All resected specimens were examined according to a standardised sampling/histopathological protocol. The following data regarding LNs were collected: total numbers; number with metastases; LNratio (metastatic/total); maximum diameter; surface area.

Results A statistically significant association was found between LN number and DFS (p=0.0473). Finding ≤9 or >20 LNs correlated with worse prognosis compared with 10–20 (p value=0.049). LNratio (>0.2) was strongly associated with shorter DFS (HR=13.36; p value <0.0001) and OS (HR=26.06; p value <0.0001). Poor outcome, for DFS (HR=2.17, p value =0.0416) and OS (HR=1.18, p value =0.0025), was associated with increasing LN surface area. LNratio was independently associated with DFS at multivariate analysis (p value <0.0001).

Conclusions LN number, LNratio and LN surface area are important prognostic factors in neoCRT-RC and in particular finding ≤9 or >20 LNs is prognostically adverse.

  • rectal cancer
  • lymph node number
  • lymph node ratio
  • neoadjuvant therapy

http://dx.doi.org/10.1136/jclinpath-2019-206139

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    Footnotes

    • Handling editor Runjan Chetty.

    • FG and LM contributed equally.

    • Contributors FP, LM and LV collected data and performed measurements; GZ performed statistical analysis; SS and ER are the surgeons who operated patients; AB and MS collected follow up; RF, FG and LM designed the study and wrote the paper.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Informed consent was obtained from all patients.

    • Ethics approval The present study obtained the approval of the Regional Ethics Committee (364REG2015) of Ospedale Policlinico San Martino (Genova, Italy). All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Declaration of Helsinki of 1964 and later versions.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. No data are available.