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Effect of Neoadjuvant Radiation Dose and Schedule on Nodal Count and Its Prognostic Impact in Stage II–III Rectal Cancer

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

It is unknown how neoadjuvant treatment schedule affects lymph node count (LNC) and lymph node ratio (LNR) and how these correlate with overall survival (OS) in rectal cancer (RC).

Methods

Data were used from the Belgian PROCARE rectal cancer registry on RC patients treated with surgery alone, short-term radiotherapy with immediate surgery (SRT), or chemoradiation with deferred surgery (CRT). The effect of neoadjuvant therapy on LNC was examined using Poisson log-linear analysis. The association of LNC and LNR with overall survival (OS) was studied using Cox proportional hazards models.

Results

Data from 4037 patients were available. Compared with surgery alone, LNC was reduced by 12.3 % after SRT and by 31.3 % after CRT (p < 0.001). In patients with surgery alone, the probability of finding node-positive disease increased with LNC, while after SRT and CRT no increase was noted for more than 12 and 18 examined nodes, respectively. Per node examined, we found a decrease in hazard of death of 2.7 % after surgery alone and 1.5 % after SRT, but no effect after CRT. In stage III patients, the LNR but not (y)pN stage was significantly correlated with OS regardless of neoadjuvant therapy. Specifically, a LNR > 0.4 was associated with a significantly worse outcome.

Conclusions

Nodal counts are reduced in a schedule-dependent manner by neoadjuvant treatment in RC. After chemoradiation, the LNC does not confer any prognostic information. A LNR of >0.4 is associated with a significantly worse outcome in stage III disease, regardless of neoadjuvant therapy type.

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Acknowledgment

The authors thank all of the teams and professionals participating in the PROCARE project. The list of participating centers can be found at www.kankerregister.org under “PROCARE statistics.” PROCARE acknowledges T. Vandendael, data manager, and the BCR for hosting the PROCARE database. PROCARE thanks the Foundation Against Cancer and the National Institute for Disease and Invalidity Assurance for their financial support.

Disclosures

None of the authors have any conflict of interest to declare. No financial or other support was received for the purpose of this study.

Author information

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium

    Wim Ceelen MD, PhD, FACS, Wouter Willaert MD & Piet Pattyn MD, PhD

  2. Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium

    Machteld Varewyck MS, Sasha Libbrecht MD & Els Goetghebeur PhD

Authors
  1. Wim Ceelen MD, PhD, FACS
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  2. Wouter Willaert MD
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  3. Machteld Varewyck MS
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  4. Sasha Libbrecht MD
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  5. Els Goetghebeur PhD
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  6. Piet Pattyn MD, PhD
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On behalf of PROCARE

Corresponding author

Correspondence to Wim Ceelen MD, PhD, FACS.

Electronic supplementary material

Below is the link to the electronic supplementary material.

10434_2016_5363_MOESM1_ESM.jpg

Ratio of survival probabilities for LNC = 21 vs LNC = 5 for patients with chemoradiation (n = 2208). Supplementary material 1 (JPEG 98 kb)

Estimated effect of pN stage vs lymph node ratio in node-positive patients. Supplementary material 2 (JPEG 349 kb)

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Ceelen, W., Willaert, W., Varewyck, M. et al. Effect of Neoadjuvant Radiation Dose and Schedule on Nodal Count and Its Prognostic Impact in Stage II–III Rectal Cancer. Ann Surg Oncol 23, 3899–3906 (2016). https://doi.org/10.1245/s10434-016-5363-4

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  • DOI: https://doi.org/10.1245/s10434-016-5363-4

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