Increased Lymph Node Yield Is Associated With Improved Survival in Rectal Cancer Irrespective of Neoadjuvant Treatment. Issue 9 (September 2015)

• Record Type: Journal Article
• Authors: Lykke, Jakob; Jess, Per; Roikjaer, Ole
• Is Part Of: Diseases of the colon & rectum. Volume 58:Issue 9(2015:Sep.)
• Publication Date: 2015-09
• Subjects: Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; Colonic Diseases -- Periodicals; Colorectal Surgery -- Periodicals; 616.34
• DOI: 10.1097/DCR.0000000000000429
• Languages: English
• ISSNs: 0012-3706

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>BACKGROUND:</title> <p>It has been proposed that the lymph node yield achieved during rectal cancer resection is associated with survival. It is debated whether a high lymph node yield improves survival, per se, or whether it does so by diminishing the International Union Against Cancer stage drifting effect.</p> </sec> <sec> <title>OBJECTIVE:</title> <p>The purpose of this study was to evaluate the prognostic implications of the lymph node yield in curative resected rectal cancer.</p> </sec> <sec> <title>DESIGN:</title> <p>This study was based on data from a prospectively maintained colorectal cancer database.</p> </sec> <sec> <title>SETTINGS:</title> <p>This was a national cohort study.</p> </sec> <sec> <title>PATIENTS:</title> <p>All 6793 patients in Denmark who were diagnosed with International Union Against Cancer stage I to III adenocarcinoma of the rectum and so treated in the period from 2003 to 2011 were included in the analysis.</p> </sec> <sec> <title>MAIN OUTCOME MEASURES:</title> <p>The primary outcome measure was overall survival.</p> </sec> <sec> <title>RESULTS:</title> <p>The observed percentages of patients with International Union Against Cancer stage III disease with a lymph node yield less than 12 or 12 or more were 28.1 % and 40.7% (<italic>p</italic> < 0.0001) in the non-neoadjuvant treatment group and 26.9% and 38.3% (<italic>p</italic> < 0.0001) in the neoadjuvant treatment group. The 5-year overall survival rates for patients with a lymph node yield <12 or 12 or more were 73.1% and 80.6% in International Union Against Cancer stages I to II (<italic>p</italic> < 0.0001) and 57.4% and 53.3% in stage III (<italic>p</italic> < 0.142) in the neoadjuvant treatment group and 70.4% and 79.2% in stages I to II (<italic>p</italic> < 0.0001) and 46.6% and 59.1% in International Union Against Cancer stage III (<italic>p</italic> < 0.0001) in the non-neoadjuvant treatment group. In multivariate analysis, the lymph node yield turned out to be an independent prognostic factor, irrespective of neoadjuvant treatment.</p> </sec> <sec> <title>LIMITATIONS:</title> <p>It is not possible in an observational study to tell whether the findings are associations rather than causal relationships.</p> </sec> <sec> <title>CONCLUSIONS:</title> <p>Increased lymph node yield was associated with better overall survival in rectal cancer, irrespective of neoadjuvant treatment. Stage migration was observed.</p> </sec> </abstract>