Maurizio Degiuli1, Simone Arolfo2, Andrea Evangelista3, Laura Lorenzon4, Rossella Reddavid5, Carlo Staudacher6, Paola De Nardi7, Riccardo Rosati7, Ugo Elmore7, Claudio Coco8, Gianluca Rizzo8, Claudio Belluco9, Marco Forlin9, Marco Milone10, Giovanni Domenico De Palma10, Daniela Rega11, Paolo Delrio11, Mario Guerrieri12, Monica Ortenzi12, Andrea Muratore13, Patrizia Marsanic13, Angelo Restivo14, Simona Deidda14, Matteo Zuin15, Salvatore Pucciarelli15, Raffaele De Luca16, Roberto Persiani4, Alberto Biondi4, Franco Roviello17, Daniele Marrelli17, Giovanni Sgroi18, Luca Turati18, Mario Morino2. 1. University of Torino, School of Medicine, Department of Oncology, Digestive Surgery and Surgical Oncology, San Luigi University Hospital, Orbassano, Torino, Italy. Electronic address: maurizio.degiuli@unito.it. 2. Digestive and Oncological Surgery, Center for Minimal Invasive Surgery, Department of Surgical Sciences, Molinette Hospital and University of Torino School of Medicine, Italy. 3. AOU Città della Salute e della Scienza University Hospital, Unit of Clinical Epidemiology and CPO, Torino, Italy. 4. Division of General Surgery, Fondazione Policlinico Universitario A Gemelli, Universita' Cattolica del Sacro Cuore, Rome, Italy. 5. University of Torino, School of Medicine, Department of Oncology, Digestive Surgery and Surgical Oncology, San Luigi University Hospital, Orbassano, Torino, Italy. 6. Department of Surgery, San Raffaele Hospital, Milan, Italy. 7. Division of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy. 8. Polo Apparato Digerente e Sistema Endocrino-Metabolico - Area Chirurgica Addominale, Fondazione Policlinico Universitario "Agostino Gemelli" - Università Cattolica del Sacro Cuore, Rome, Italy. 9. Department of Surgical Oncology, CRO-IRCCS, National Cancer Institute, Aviano, Italy. 10. Advanced Biomedical Sciences Department, "Federico II" University, AOU "Federico II", Naples Italy. 11. Colorectal Surgical Oncology, National Cancer Institute - IRCCS - G. Pascale Foundation, Napoli, Italy. 12. Clinica Chirurgica, Azienda Ospedaliero-Universitaria Torrette di Ancona, Italy. 13. Division of General Surgery, E. Agnelli Hospital, Pinerolo (Torino), Italy. 14. Colorectal Surgery, A.O.U. Cagliari, Department of Surgical Science, University of Cagliari, Italy. 15. Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Italy. 16. National Cancer Institute, Research Centre, Giovanni Paolo II, Surgery Unit, Bari, Italy. 17. Department of General Surgery, Azienda Ospedaliero-Universitaria Senese, Nuovo Policlinico Le Scotte, Siena, Italy. 18. Surgical Oncology, Ospedale Treviglio - ASST Bergamo Ovest Piazza Meneguzzo, 1 - 24047 Treviglio (BG), Italy.
Abstract
INTRODUCTION: We retrospectively investigated the impact of number or complete absence of nodes retrieved on survival of patients with rectal cancer (RC) treated with neoadjuvant radiation-therapy (NAT). METHODS: All patients with RC treated with NAT followed by curative surgery from 2000 to 2014 in 14 Italian referral Centres for Colorectal Surgery were enrolled. Information about number of nodes harvested, node ratio, type of radiation therapy schedule and tumour stage were recorded. Impact of number or complete absence of nodes retrieved on overall survival (OS) and on cumulative incidence of death for disease (CIDD) was assessed and factors influencing node yield were investigated. RESULTS: In total, 1407 patients were included. Mean number of nodes retrieved was 12.9, while no lymph nodes were found in only 32 patients (2%, ypNnull). Definite nodal stage was ypN0 in 1001 patients (71%) and ypN+ in 372 patients (27%). In multivariable analysis ypNnull patients showed worse OS and CIDD compared to both ypN0 and ypN+. In ypN0 patients, number of nodes assessed, stratified in 4 groups (<5, 5-10, 11-15 and > 15), did not significantly influence OS and CIDD. Long-course radiation schedule and early T stages negatively affected node assessment. CONCLUSION: Complete absence of nodes assessed was associated with worse prognosis compared to node-negative and node-positive patients. In node-negative patients number of nodes was not associated to OS and CIDD. Based on data from this large population of irradiated RC, number of nodes assessed has no prognostic impact in node-negative patients.
INTRODUCTION: We retrospectively investigated the impact of number or complete absence of nodes retrieved on survival of patients with rectal cancer (RC) treated with neoadjuvant radiation-therapy (NAT). METHODS: All patients with RC treated with NAT followed by curative surgery from 2000 to 2014 in 14 Italian referral Centres for Colorectal Surgery were enrolled. Information about number of nodes harvested, node ratio, type of radiation therapy schedule and tumour stage were recorded. Impact of number or complete absence of nodes retrieved on overall survival (OS) and on cumulative incidence of death for disease (CIDD) was assessed and factors influencing node yield were investigated. RESULTS: In total, 1407 patients were included. Mean number of nodes retrieved was 12.9, while no lymph nodes were found in only 32 patients (2%, ypNnull). Definite nodal stage was ypN0 in 1001 patients (71%) and ypN+ in 372 patients (27%). In multivariable analysis ypNnull patients showed worse OS and CIDD compared to both ypN0 and ypN+. In ypN0 patients, number of nodes assessed, stratified in 4 groups (<5, 5-10, 11-15 and > 15), did not significantly influence OS and CIDD. Long-course radiation schedule and early T stages negatively affected node assessment. CONCLUSION: Complete absence of nodes assessed was associated with worse prognosis compared to node-negative and node-positive patients. In node-negative patients number of nodes was not associated to OS and CIDD. Based on data from this large population of irradiated RC, number of nodes assessed has no prognostic impact in node-negative patients.
Authors: Marcin Zeman; Marek Czarnecki; Ewa Chmielik; Adam Idasiak; Władysław Skałba; Mirosław Strączyński; Piotr J Paul; Agnieszka Czarniecka Journal: World J Surg Oncol Date: 2021-05-21 Impact factor: 2.754