Lymph nodes regression grade is a predictive marker for rectal cancer after neoadjuvant therapy and radical surgery
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Jun Li1, Jiatian Yuan1, Hao Liu2, Jie Yin3, Sai Liu4, Feng Du5, Junjie Hu6, Ci Li7, Xiangke Niu8, Bo Lv1, Shasha Xing9
1General Surgery Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, P.R. China
2General Surgery Department, Second Affiliated Hospital of Jilin University, Changchun, P.R. China
3General Surgery Department, Xuzhou Central Hospital, Xuzhou, P.R. China
4Surgical Department of Gastrointestinal Diseases, Beijing Youan Hospital of Capital Medical University, Beijing, P.R. China
5Internal Medicine-Oncology, Cancer Institute/Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P.R. China
6Gastrointestinal Tumor Surgery, Hubei Cancer Hospital, Wuhan, P.R. China
7Department of Pathology, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, P.R. China
8Department of Radiology, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, P.R. China
9Central Lab, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, P.R. China
Jun Li, e-mail: email@example.com
Jiatian Yuan, e-mail: firstname.lastname@example.org
Shasha Xing, e-mail: email@example.com
Keywords: lymph node, regression grading, rectal cancer, neoadjuvant therapy
Received: October 10, 2015 Accepted: February 08, 2016 Published: February 25, 2016
Neoadjuvant therapy (NT) for rectal cancer (RC) reduces primary tumors and involved lymph nodes. While a prognostic value of tumor regression grade (TRG) has been identified, involved lymph node regression grade (LRG) has not been systematically evaluated. Here, we evaluated the association of LRG with oncologic outcomes of RC patients after NT followed by radical surgery. 347 patients with locally advanced RC who received NT and then underwent radical surgery were retrospectively recruited between 2004 and 2011. Response to NT was evaluated by a 3-tier LRG and TRG based on the ratio of residual tumor to fibrosis. LRG was assessed in all patients (LRG 0, 170 patients [49.0%]; LRG 1, 100 patients [28.8%]; and LRG 2, 77 patients [22.2%]). LRG correlated with 5-year distant metastasis and 5-year disease free survival (p=0.029 and 0.023, respectively). LRG also correlated with TRG (p=0.017). We conclude that the LRG system may be an independent predictive factor of long-term oncologic outcomes of rectal cancer patients after NT and radical surgery.
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