BACKGROUND AND AIMS: Neoadjuvant chemoradiotherapy (nCRT) has been established as standard treatment for locally advanced rectal cancer (cT3/4 or cN+ cM0, distance from circumferential resection margin ≤1 mm) to enhance local disease control and minimize the rate of locoregional recurrence. As a consequence of downstaging, a significant proportion of patients show non-viable tumor deposits within regional lymph nodes that qualify as ypN0 according to the current TNM classification irrespective of the actual pre-treatment status. Accordingly, the prognostic relevance of ypN0 status as compared with true pN0 without preceding nCRT is not known. PATIENTS AND METHODS: We retrospectively analyzed 132 patients who underwent standard total mesorectal excision (TME) surgery after nCRT for rectal carcinoma and were classified as ypN0, and compared their prognoses with those of 341 patients with pN0 without nCRT. RESULTS: Re-evaluation of regional lymph nodes after nCRT showed no evidence of previous metastasis in 91 cases (ypN0(-)), sure but non-viable metastasis in 14 patients (ypN0(+)), and unsure status in 27 patients (ypN0(X)). The local recurrence rate, distant metastases, and disease-free, observed, and cancer-related survival were similar in all subgroups (p = 0.447, 0.695, 0.759, 0.655, and 0.354, respectively). CONCLUSION: Our results showed a similar outcome in patients with ypN0 and in the control group with pN0 regarding local recurrence rate, distant metastases, and disease-free, observed, and cancer-related survival. Validation of these results is necessary to clarify the questions regarding postoperative adjuvant chemotherapy for patients with ypN0(+).
BACKGROUND AND AIMS: Neoadjuvant chemoradiotherapy (nCRT) has been established as standard treatment for locally advanced rectal cancer (cT3/4 or cN+ cM0, distance from circumferential resection margin ≤1 mm) to enhance local disease control and minimize the rate of locoregional recurrence. As a consequence of downstaging, a significant proportion of patients show non-viable tumor deposits within regional lymph nodes that qualify as ypN0 according to the current TNM classification irrespective of the actual pre-treatment status. Accordingly, the prognostic relevance of ypN0 status as compared with true pN0 without preceding nCRT is not known. PATIENTS AND METHODS: We retrospectively analyzed 132 patients who underwent standard total mesorectal excision (TME) surgery after nCRT for rectal carcinoma and were classified as ypN0, and compared their prognoses with those of 341 patients with pN0 without nCRT. RESULTS: Re-evaluation of regional lymph nodes after nCRT showed no evidence of previous metastasis in 91 cases (ypN0(-)), sure but non-viable metastasis in 14 patients (ypN0(+)), and unsure status in 27 patients (ypN0(X)). The local recurrence rate, distant metastases, and disease-free, observed, and cancer-related survival were similar in all subgroups (p = 0.447, 0.695, 0.759, 0.655, and 0.354, respectively). CONCLUSION: Our results showed a similar outcome in patients with ypN0 and in the control group with pN0 regarding local recurrence rate, distant metastases, and disease-free, observed, and cancer-related survival. Validation of these results is necessary to clarify the questions regarding postoperative adjuvant chemotherapy for patients with ypN0(+).
Authors: Filippo Spreafico; Lorenza Gandola; Paolo D'Angelo; Monica Terenziani; Paola Collini; Maurizio Bianchi; Massimo Provenzi; Paolo Indolfi; Andrea Pession; Marilina Nantron; Andrea Di Cataldo; Alfonso Marchianò; Serena Catania; Franca Fossati Bellani; Luigi Piva Journal: Int J Radiat Oncol Biol Phys Date: 2010-11-13 Impact factor: 7.038
Authors: Rolf Sauer; Heinz Becker; Werner Hohenberger; Claus Rödel; Christian Wittekind; Rainer Fietkau; Peter Martus; Jörg Tschmelitsch; Eva Hager; Clemens F Hess; Johann-H Karstens; Torsten Liersch; Heinz Schmidberger; Rudolf Raab Journal: N Engl J Med Date: 2004-10-21 Impact factor: 91.245
Authors: M Caricato; F Ausania; E De Dominicis; B Vincenzi; C Rabitti; G Tonini; F Cellini; R Coppola Journal: Eur J Surg Oncol Date: 2007-03-01 Impact factor: 4.424
Authors: Thilo Sprenger; Hilka Rothe; Klaus Jung; Hans Christiansen; Lena C Conradi; B Michael Ghadimi; Heinz Becker; Torsten Liersch Journal: World J Surg Oncol Date: 2010-04-13 Impact factor: 2.754