PT  - JOURNAL ARTICLE
AU  - Francesca Pitto
AU  - Gabriele Zoppoli
AU  - Stefano Scabini
AU  - Emanuele Romairone
AU  - Roberto Fiocca
AU  - Alberto Ballestrero
AU  - Marco Sparavigna
AU  - Lara Malaspina
AU  - Luca Valle
AU  - Federica Grillo
AU  - Luca Mastracci
TI  - Lymph node number, surface area and lymph node ratio are important prognostic indicators in neoadjuvant chemoradiotherapy treated rectal cancer
AID  - 10.1136/jclinpath-2019-206139
DP  - 2020 Mar 01
TA  - Journal of Clinical Pathology
PG  - 162--166
VI  - 73
IP  - 3
4099  - http://jcp.bmj.com/content/73/3/162.short
4100  - http://jcp.bmj.com/content/73/3/162.full
SO  - J Clin Pathol2020 Mar 01; 73
AB  - 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.