H E Haak1,2, G L Beets1,2, K Peeters3, P J Nelemans4, V Valentini5, C Rödel6, L Kuo7, F A Calvo8, J Garcia-Aguilar9, R Glynne-Jones10, S Pucciarelli11, J Suarez12, G Theodoropoulos13, S Biondo14,15, D M J Lambregts16, R G H Beets-Tan2,16, M Maas16. 1. Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands. 2. GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands. 3. Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands. 4. Department of Epidemiology, Maastricht University Medical Centre, Maastricht, the Netherlands. 5. Department of Radiation Oncology, Universita Cattolica del Sacro Cuore, Rome, Italy. 6. Department of Radiation Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany. 7. Department of Colorectal Surgery, Taipei Medical University Hospital, Taipei, Taiwan. 8. Department of Oncology, General University Hospital Gregorio Marañón, Madrid, Spain. 9. Department of Surgery, Memorial Sloan Kettering Cancer Centre, New York, USA. 10. Department of Clinical Oncology, Mount Vernon Hospital, London, UK. 11. Department of Surgical, Oncological and Gastroenterological Sciences, First Surgical Clinic, University of Padua, Padua, Italy. 12. Department of Surgery, Hospital de Navarra, Pamplona, Spain. 13. First Department of Propaedeutic Surgery, Athens Medical School, Hippocration General Hospital, Athens, Greece. 14. Department of Surgery, Bellvitge University Hospital, Barcelona, Spain. 15. IDIBELL, University of Barcelona, Barcelona, Spain. 16. Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
Abstract
BACKGROUND: The purpose of this study was to investigate the prevalence of ypN+ status according to ypT category in patients with locally advanced rectal cancer treated with chemoradiotherapy and total mesorectal excision, and to assess the impact of ypN+ on disease recurrence and survival by pooled analysis of individual-patient data. METHODS: Individual-patient data from 10 studies of chemoradiotherapy for rectal cancer were included. Pooled rates of ypN+ disease were calculated with 95 per cent confidence interval for each ypT category. Kaplan-Meier and Cox regression analyses were undertaken to assess influence of ypN status on 5-year disease-free survival (DFS) and overall survival (OS). RESULTS: Data on 1898 patients were included in the study. Median follow-up was 50 (range 0-219) months. The pooled rate of ypN+ disease was 7 per cent for ypT0, 12 per cent for ypT1, 17 per cent for ypT2, 40 per cent for ypT3, and 46 per cent for ypT4 tumours. Patients with ypN+ disease had lower 5-year DFS and OS (46.2 and 63.4 per cent respectively) than patients with ypN0 tumours (74.5 and 83.2 per cent) (P < 0.001). Cox regression analyses showed ypN+ status to be an independent predictor of recurrence and death. CONCLUSION: Risk of nodal metastases (ypN+) after chemoradiotherapy increases with advancing ypT category and needs to be considered if an organ-preserving strategy is contemplated.
BACKGROUND: The purpose of this study was to investigate the prevalence of ypN+ status according to ypT category in patients with locally advanced rectal cancer treated with chemoradiotherapy and total mesorectal excision, and to assess the impact of ypN+ on disease recurrence and survival by pooled analysis of individual-patient data. METHODS: Individual-patient data from 10 studies of chemoradiotherapy for rectal cancer were included. Pooled rates of ypN+ disease were calculated with 95 per cent confidence interval for each ypT category. Kaplan-Meier and Cox regression analyses were undertaken to assess influence of ypN status on 5-year disease-free survival (DFS) and overall survival (OS). RESULTS: Data on 1898 patients were included in the study. Median follow-up was 50 (range 0-219) months. The pooled rate of ypN+ disease was 7 per cent for ypT0, 12 per cent for ypT1, 17 per cent for ypT2, 40 per cent for ypT3, and 46 per cent for ypT4 tumours. Patients with ypN+ disease had lower 5-year DFS and OS (46.2 and 63.4 per cent respectively) than patients with ypN0 tumours (74.5 and 83.2 per cent) (P < 0.001). Cox regression analyses showed ypN+ status to be an independent predictor of recurrence and death. CONCLUSION: Risk of nodal metastases (ypN+) after chemoradiotherapy increases with advancing ypT category and needs to be considered if an organ-preserving strategy is contemplated.
Authors: Marije P van der Paardt; Marjolein B Zagers; Regina G H Beets-Tan; Jaap Stoker; Shandra Bipat Journal: Radiology Date: 2013-06-25 Impact factor: 11.105
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Authors: R Hughes; R Glynne-Jones; J Grainger; P Richman; A Makris; M Harrison; R Ashford; R A Harrison; J I Livingstone; P J McDonald; J Meyrick Thomas; I C Mitchell; J M A Northover; R Phillips; M Wallace; A Windsor; J R Novell Journal: Int J Colorectal Dis Date: 2005-04-30 Impact factor: 2.571
Authors: Juan A Díaz-González; Felipe A Calvo; Javier Cortés; José L García-Sabrido; Marina Gómez-Espí; Emilio Del Valle; Fernando Muñoz-Jiménez; Emilio Alvarez Journal: Int J Radiat Oncol Biol Phys Date: 2006-01-06 Impact factor: 7.038
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