Prognostic importance of lymph node count and ratio in rectal cancer after neoadjuvant chemoradiotherapy: Results from a cross-sectional study

the Dutch Snapshot Research Group

doi:10.1002/jso.26522

Prognostic importance of lymph node count and ratio in rectal cancer after neoadjuvant chemoradiotherapy: Results from a cross-sectional study

the Dutch Snapshot Research Group

University of Amsterdam
Isala Clinics
Netherlands Cancer Institute

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background: The aim of this study was to determine the prognostic value of lymph node count (LNC) and lymph node ratio (LNR) in rectal cancer after neoadjuvant chemoradiotherapy (CRT). Methods: Patients who underwent neoadjuvant CRT and total mesorectal excision (TME) for Stage I–III rectal cancer were selected from a cross-sectional study including 71 Dutch centres. Primary outcome parameters were disease-free survival (DFS) and overall survival (OS). Prognostic significance of LNC and LNR (cut-off values 0.15, 0.20, 0.30) was tested for different (sub)groups. Results: From 2095 registered patients, 458 were included, of which 240 patients with LNC < 12 and 218 patients with LNC ≥ 12. LNC was not significantly associated with DFS (p = 0.35) and OS (p = 0.59). In univariable analysis, LNR was significantly associated with DFS and OS in the whole cohort and LNC subgroups, but not in multivariable analysis. Conclusions: LNC was not associated with long-term oncological outcome in rectal cancer patients treated with CRT, nor was LNR when corrected for N-stage. However, LNR might be used to identify subgroups of node-positive patients with a favourable outcome.

Original language	English
Pages (from-to)	367-377
Number of pages	11
Journal	Journal of surgical oncology
Volume	124
Issue number	3
Early online date	2021
DOIs	https://doi.org/10.1002/jso.26522
Publication status	Published - 1 Sept 2021

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

chemoradiotherapy
disease-free survival
lymph nodes
rectal cancer
survival

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10.1002/jso.26522

Prognostic-importance-of-lymph-node-count-and-ratio-in-rectal-cancer-after-neoadjuvant-chemoradiotherapy-results-from-a.pdfFinal published version, 1.64 MBLicence: Taverne

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@article{a809afe9e251446db0fa2eeeb6ebd59a,

title = "Prognostic importance of lymph node count and ratio in rectal cancer after neoadjuvant chemoradiotherapy: Results from a cross-sectional study",

abstract = "Background: The aim of this study was to determine the prognostic value of lymph node count (LNC) and lymph node ratio (LNR) in rectal cancer after neoadjuvant chemoradiotherapy (CRT). Methods: Patients who underwent neoadjuvant CRT and total mesorectal excision (TME) for Stage I–III rectal cancer were selected from a cross-sectional study including 71 Dutch centres. Primary outcome parameters were disease-free survival (DFS) and overall survival (OS). Prognostic significance of LNC and LNR (cut-off values 0.15, 0.20, 0.30) was tested for different (sub)groups. Results: From 2095 registered patients, 458 were included, of which 240 patients with LNC < 12 and 218 patients with LNC ≥ 12. LNC was not significantly associated with DFS (p = 0.35) and OS (p = 0.59). In univariable analysis, LNR was significantly associated with DFS and OS in the whole cohort and LNC subgroups, but not in multivariable analysis. Conclusions: LNC was not associated with long-term oncological outcome in rectal cancer patients treated with CRT, nor was LNR when corrected for N-stage. However, LNR might be used to identify subgroups of node-positive patients with a favourable outcome.",

keywords = "chemoradiotherapy, disease-free survival, lymph nodes, rectal cancer, survival",

author = "Robin Detering and Meyer, \{Vincent M.\} and Borstlap, \{Wernard A. A.\} and Beets-Tan, \{Regina G. H.\} and Marijnen, \{Corrie A. M.\} and Roel Hompes and Tanis, \{Pieter J.\} and \{van Westreenen\}, \{Henderik L.\} and \{the Dutch Snapshot Research Group\} and Aalbers, \{A. G. J.\} and Y. Acherman and Algie, \{G. D.\} and \{Alting von Geusau\}, B. and F. Amelung and Aukema, \{T. S.\} and Bakker, \{I. S.\} and Bartels, \{S. A.\} and S. Basha and Bastiaansen, \{A. J. N. M.\} and E. Belgers and W. Bleeker and J. Blok and Bosker, \{R. J. I.\} and Bosmans, \{J. W.\} and Boute, \{M. C.\} and Bouvy, \{N. D.\} and H. Bouwman and A. Brandt-Kerkhof and Brinkman, \{D. J.\} and S. Bruin and Bruns, \{E. R. J.\} and Burbach, \{J. P. M.\} and Burger, \{J. W. A.\} and Buskens, \{C. J.\} and S. Clermonts and Coene, \{P. P. L. O.\} and C. Compaan and \{de Mik\}, \{S. M. L.\} and \{van Duijvendijk\}, P. and Gooszen, \{J. A. H.\} and P. Hoogland and B. Lamme and Marres, \{C. C.\} and Musters, \{G. D.\} and \{van Rossem\}, \{C. C.\} and Schreuder, \{A. M.\} and Swank, \{H. A.\} and Tuynman, \{J. B.\} and \{van Beek\}, \{S. C.\} and \{van Westreenen\}, \{H. L.\} and E. Westerduin and Consten, \{E. C. J.\} and T. Darbyshire and \{de Graaf\}, \{E. J. R.\} and \{de Groot\}, I. and \{de Vos tot Nederveen Cappel\}, \{R. J.\} and \{de Wilt\}, \{J. H. W.\} and \{van der Wolde\}, J. and \{den Boer\}, \{F. C.\} and Dekker, \{J. W. T.\} and A. Demirkiran and M. Derkx-Hendriksen and Dijkstra, \{F. R.\} and Dunker, \{M. S.\} and Eijsbouts, \{Q. E.\} and H. Fabry and F. Ferenschild and Foppen, \{J. W.\} and Furnee, \{E. J. B.\} and Gerhards, \{M. F.\} and P. Gerven and Govaert, \{J. A.\} and \{van Grevenstein\}, \{W. M. U.\} and R. Haen and Harlaar, \{J. J.\} and \{van der Harst\}, E. and K. Havenga and J. Heemskerk and Heeren, \{J. F.\} and B. Heijnen and P. Heres and C. Hoff and W. Hogendoorn and A. Huijbers and P. Janssen and Jongen, \{A. C.\} and Jonker, \{F. H.\} and Karthaus, \{E. G.\} and A. Keijzer and Ketel, \{J. M. A.\} and J. Klaase and Kloppenberg, \{F. W. H.\} and Kool, \{M. E.\} and R. Kortekaas and Kruyt, \{P. M.\} and Kuiper, \{J. T.\} and Lange, \{J. F.\} and T. Lettinga and Lips, \{D. J.\} and F. Logeman and \{Lutke Holzik\}, \{M. F.\} and E. Madsen and A. Mamound and I. Masselink and M. Meerdink and Menon, \{A. G.\} and Mieog, \{J. S.\} and D. Mierlo and Nieuwenhuijzen, \{G. A. P.\} and Neijenhuis, \{P. A.\} and J. Nonner and M. Oostdijk and Oosterling, \{S. J.\} and Paul, \{P. M. P.\} and Peeters, \{K. C. M. J.\} and Pereboom, \{I. T. A.\} and F. Polat and P. Poortman and M. Raber and Reiber, \{B. M. M.\} and Renger, \{R. J.\} and Rutten, \{H. J.\} and A. Rutten and R. Schaapman and M. Scheer and L. Schoonderwoerd and N. Schouten and Schreurs, \{W. H.\} and Simkens, \{G. A.\} and Slooter, \{G. D.\} and Sluijmer, \{H. C. E.\} and N. Smakman and R. Smeenk and Snijders, \{H. S.\} and Sonneveld, \{D. J. A.\} and B. Spaansen and \{Spillenaar Bilgen\}, \{E. J.\} and E. Steller and Steup, \{W. H.\} and C. Steur and E. Stortelder and J. Straatman and C. Sietses and Groen, \{H. A.\} and \{ten Hoeve\}, \{H. G.\} and \{ter Riele\}, \{W. W.\} and Thorensen, \{I. M.\} and B. Tip-Pluijm and Toorenvliet, \{B. R.\} and L. Tseng and \{van Bastelaar\}, J. and \{van de Ven\}, \{A. W. H.\} and \{van de Weijer\}, \{M. A. J.\} and \{van den Berg\}, C. and \{van den Bosch\}, I. and \{van der Bilt\}, \{J. D. W.\} and \{van der Hagen\}, \{S. J.\} and \{van der Hul\}, R. and \{van der Schelling\}, G. and \{van der Spek\}, A. and \{van der Wielen\}, N. and \{van Duyn\}, E. and \{van Eekelen\}, C. and \{van Essen\}, \{J. A.\} and \{van Gangelt\}, K. and \{van Geloven\}, \{A. A. W.\} and \{van Kessel\}, C. and \{van Loon\}, \{Y. T.\} and \{van Rijswijk\}, A. and \{van Rooijen\}, \{S. J.\} and \{van Sprundel\}, T. and \{van Steensel\}, L. and \{van Tets\}, \{W. F.\} and S. Veltkamp and T. Verhaak and Verheijen, \{P. M.\} and L. Versluis-Ossenwaarde and S. Vijfhuize and Vles, \{W. J.\} and Voeten, \{S. C.\} and Vogelaar, \{F. J.\} and Vrijland, \{W. W.\} and Westerterp, \{M. E.\} and M. Wetzel and Wevers, \{K. P.\} and B. Wiering and Witjes, \{C. D. M.\} and Wouters, \{M. W.\} and Yauw, \{S. T. K.\} and \{van der Zaag\}, \{E. S.\} and Zeestraten, \{E. C.\} and Zimmerman, \{D. D. E.\} and T. Zwieten",

note = "Funding Information: This study was conducted by the Dutch Snapshot Research Group (DSRG) and the authors would like to thank all registrars for retrospective collecting data in participating Dutch hospitals. The Snapshot study group received a research grant from the Dutch Cancer Society for their work in the past. Author P.J.T. received an unrestricted research grant from Allergan (LifeCell). Publisher Copyright: {\textcopyright} 2021 Wiley Periodicals LLC Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = sep,

day = "1",

doi = "10.1002/jso.26522",

language = "English",

volume = "124",

pages = "367--377",

journal = "Journal of surgical oncology",

issn = "0022-4790",

publisher = "Wiley-Liss Inc.",

number = "3",

}

TY - JOUR

T1 - Prognostic importance of lymph node count and ratio in rectal cancer after neoadjuvant chemoradiotherapy: Results from a cross-sectional study

AU - Detering, Robin

AU - Meyer, Vincent M.

AU - Borstlap, Wernard A. A.

AU - Beets-Tan, Regina G. H.

AU - Marijnen, Corrie A. M.

AU - Hompes, Roel

AU - Tanis, Pieter J.

AU - van Westreenen, Henderik L.

AU - the Dutch Snapshot Research Group

AU - Aalbers, A. G. J.

AU - Acherman, Y.

AU - Algie, G. D.

AU - Alting von Geusau, B.

AU - Amelung, F.

AU - Aukema, T. S.

AU - Bakker, I. S.

AU - Bartels, S. A.

AU - Basha, S.

AU - Bastiaansen, A. J. N. M.

AU - Belgers, E.

AU - Bleeker, W.

AU - Blok, J.

AU - Bosker, R. J. I.

AU - Bosmans, J. W.

AU - Boute, M. C.

AU - Bouvy, N. D.

AU - Bouwman, H.

AU - Brandt-Kerkhof, A.

AU - Brinkman, D. J.

AU - Bruin, S.

AU - Bruns, E. R. J.

AU - Burbach, J. P. M.

AU - Burger, J. W. A.

AU - Buskens, C. J.

AU - Clermonts, S.

AU - Coene, P. P. L. O.

AU - Compaan, C.

AU - de Mik, S. M. L.

AU - van Duijvendijk, P.

AU - Gooszen, J. A. H.

AU - Hoogland, P.

AU - Lamme, B.

AU - Marres, C. C.

AU - Musters, G. D.

AU - van Rossem, C. C.

AU - Schreuder, A. M.

AU - Swank, H. A.

AU - Tuynman, J. B.

AU - van Beek, S. C.

AU - van Westreenen, H. L.

AU - Westerduin, E.

AU - Consten, E. C. J.

AU - Darbyshire, T.

AU - de Graaf, E. J. R.

AU - de Groot, I.

AU - de Vos tot Nederveen Cappel, R. J.

AU - de Wilt, J. H. W.

AU - van der Wolde, J.

AU - den Boer, F. C.

AU - Dekker, J. W. T.

AU - Demirkiran, A.

AU - Derkx-Hendriksen, M.

AU - Dijkstra, F. R.

AU - Dunker, M. S.

AU - Eijsbouts, Q. E.

AU - Fabry, H.

AU - Ferenschild, F.

AU - Foppen, J. W.

AU - Furnee, E. J. B.

AU - Gerhards, M. F.

AU - Gerven, P.

AU - Govaert, J. A.

AU - van Grevenstein, W. M. U.

AU - Haen, R.

AU - Harlaar, J. J.

AU - van der Harst, E.

AU - Havenga, K.

AU - Heemskerk, J.

AU - Heeren, J. F.

AU - Heijnen, B.

AU - Heres, P.

AU - Hoff, C.

AU - Hogendoorn, W.

AU - Huijbers, A.

AU - Janssen, P.

AU - Jongen, A. C.

AU - Jonker, F. H.

AU - Karthaus, E. G.

AU - Keijzer, A.

AU - Ketel, J. M. A.

AU - Klaase, J.

AU - Kloppenberg, F. W. H.

AU - Kool, M. E.

AU - Kortekaas, R.

AU - Kruyt, P. M.

AU - Kuiper, J. T.

AU - Lange, J. F.

AU - Lettinga, T.

AU - Lips, D. J.

AU - Logeman, F.

AU - Lutke Holzik, M. F.

AU - Madsen, E.

AU - Mamound, A.

AU - Masselink, I.

AU - Meerdink, M.

AU - Menon, A. G.

AU - Mieog, J. S.

AU - Mierlo, D.

AU - Nieuwenhuijzen, G. A. P.

AU - Neijenhuis, P. A.

AU - Nonner, J.

AU - Oostdijk, M.

AU - Oosterling, S. J.

AU - Paul, P. M. P.

AU - Peeters, K. C. M. J.

AU - Pereboom, I. T. A.

AU - Polat, F.

AU - Poortman, P.

AU - Raber, M.

AU - Reiber, B. M. M.

AU - Renger, R. J.

AU - Rutten, H. J.

AU - Rutten, A.

AU - Schaapman, R.

AU - Scheer, M.

AU - Schoonderwoerd, L.

AU - Schouten, N.

AU - Schreurs, W. H.

AU - Simkens, G. A.

AU - Slooter, G. D.

AU - Sluijmer, H. C. E.

AU - Smakman, N.

AU - Smeenk, R.

AU - Snijders, H. S.

AU - Sonneveld, D. J. A.

AU - Spaansen, B.

AU - Spillenaar Bilgen, E. J.

AU - Steller, E.

AU - Steup, W. H.

AU - Steur, C.

AU - Stortelder, E.

AU - Straatman, J.

AU - Sietses, C.

AU - Groen, H. A.

AU - ten Hoeve, H. G.

AU - ter Riele, W. W.

AU - Thorensen, I. M.

AU - Tip-Pluijm, B.

AU - Toorenvliet, B. R.

AU - Tseng, L.

AU - van Bastelaar, J.

AU - van de Ven, A. W. H.

AU - van de Weijer, M. A. J.

AU - van den Berg, C.

AU - van den Bosch, I.

AU - van der Bilt, J. D. W.

AU - van der Hagen, S. J.

AU - van der Hul, R.

AU - van der Schelling, G.

AU - van der Spek, A.

AU - van der Wielen, N.

AU - van Duyn, E.

AU - van Eekelen, C.

AU - van Essen, J. A.

AU - van Gangelt, K.

AU - van Geloven, A. A. W.

AU - van Kessel, C.

AU - van Loon, Y. T.

AU - van Rijswijk, A.

AU - van Rooijen, S. J.

AU - van Sprundel, T.

AU - van Steensel, L.

AU - van Tets, W. F.

AU - Veltkamp, S.

AU - Verhaak, T.

AU - Verheijen, P. M.

AU - Versluis-Ossenwaarde, L.

AU - Vijfhuize, S.

AU - Vles, W. J.

AU - Voeten, S. C.

AU - Vogelaar, F. J.

AU - Vrijland, W. W.

AU - Westerterp, M. E.

AU - Wetzel, M.

AU - Wevers, K. P.

AU - Wiering, B.

AU - Witjes, C. D. M.

AU - Wouters, M. W.

AU - Yauw, S. T. K.

AU - van der Zaag, E. S.

AU - Zeestraten, E. C.

AU - Zimmerman, D. D. E.

AU - Zwieten, T.

N1 - Funding Information: This study was conducted by the Dutch Snapshot Research Group (DSRG) and the authors would like to thank all registrars for retrospective collecting data in participating Dutch hospitals. The Snapshot study group received a research grant from the Dutch Cancer Society for their work in the past. Author P.J.T. received an unrestricted research grant from Allergan (LifeCell). Publisher Copyright: © 2021 Wiley Periodicals LLC Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/9/1

Y1 - 2021/9/1

N2 - Background: The aim of this study was to determine the prognostic value of lymph node count (LNC) and lymph node ratio (LNR) in rectal cancer after neoadjuvant chemoradiotherapy (CRT). Methods: Patients who underwent neoadjuvant CRT and total mesorectal excision (TME) for Stage I–III rectal cancer were selected from a cross-sectional study including 71 Dutch centres. Primary outcome parameters were disease-free survival (DFS) and overall survival (OS). Prognostic significance of LNC and LNR (cut-off values 0.15, 0.20, 0.30) was tested for different (sub)groups. Results: From 2095 registered patients, 458 were included, of which 240 patients with LNC < 12 and 218 patients with LNC ≥ 12. LNC was not significantly associated with DFS (p = 0.35) and OS (p = 0.59). In univariable analysis, LNR was significantly associated with DFS and OS in the whole cohort and LNC subgroups, but not in multivariable analysis. Conclusions: LNC was not associated with long-term oncological outcome in rectal cancer patients treated with CRT, nor was LNR when corrected for N-stage. However, LNR might be used to identify subgroups of node-positive patients with a favourable outcome.

AB - Background: The aim of this study was to determine the prognostic value of lymph node count (LNC) and lymph node ratio (LNR) in rectal cancer after neoadjuvant chemoradiotherapy (CRT). Methods: Patients who underwent neoadjuvant CRT and total mesorectal excision (TME) for Stage I–III rectal cancer were selected from a cross-sectional study including 71 Dutch centres. Primary outcome parameters were disease-free survival (DFS) and overall survival (OS). Prognostic significance of LNC and LNR (cut-off values 0.15, 0.20, 0.30) was tested for different (sub)groups. Results: From 2095 registered patients, 458 were included, of which 240 patients with LNC < 12 and 218 patients with LNC ≥ 12. LNC was not significantly associated with DFS (p = 0.35) and OS (p = 0.59). In univariable analysis, LNR was significantly associated with DFS and OS in the whole cohort and LNC subgroups, but not in multivariable analysis. Conclusions: LNC was not associated with long-term oncological outcome in rectal cancer patients treated with CRT, nor was LNR when corrected for N-stage. However, LNR might be used to identify subgroups of node-positive patients with a favourable outcome.

KW - chemoradiotherapy

KW - disease-free survival

KW - lymph nodes

KW - rectal cancer

KW - survival

UR - https://www.scopus.com/pages/publications/85105721092

U2 - 10.1002/jso.26522

DO - 10.1002/jso.26522

M3 - Article

C2 - 33988882

SN - 0022-4790

VL - 124

SP - 367

EP - 377

JO - Journal of surgical oncology

JF - Journal of surgical oncology

IS - 3

ER -

Prognostic importance of lymph node count and ratio in rectal cancer after neoadjuvant chemoradiotherapy: Results from a cross-sectional study

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Keywords

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