Neoadjuvant therapy for rectal cancer affects lymph node yield and status without clear implications on outcome: The case for eliminating a metric and using preoperative staging to guide therapy

Sherif R.Z. Abdel-Misih*, Lai Wei, Al B Benson III, Steven Cohen, Lily Lai, John Skibber, Neal Wilkinson, Martin Weiser, Deborah Schrag, Tanios Bekaii-Saab

*Corresponding author for this work

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Nodal status has long been considered pivotal to oncologic care, staging, and management. This has resulted in the establishment of rudimentary metrics regarding adequate lymph node yield in colon and rectal cancers for accurate cancer staging. In the era of neoadjuvant treatment, the implications of lymph node yield and status on patient outcomes remains unclear. Patient and Methods: This study included 1,680 patients with locally advanced rectal cancer from the NCCN prospective oncology database stratified into 3 groups based on preoperative therapy received: no neoadjuvant therapy, neoadjuvant chemoradiation, and neoadjuvant chemotherapy. Clinicopathologic characteristics and survival were compared between the groups, with univariate and multivariate analyses undertaken. Results: The clinicopathologic characteristics demonstrated statistically significant differences and heterogeneity among the 3 groups. The neoadjuvant chemoradiation group demonstrated the statistically lowest median lymph node yield (n=15) compared with 17 and 18 for no-neoadjuvant and neoadjuvant chemotherapy, respectively (P<.0001). Neoadjuvant treatment did impact survival, with chemoradiation demonstrating increased median overall survival of 42.7 compared with 37.3 and 26.6 months for neoadjuvant chemotherapy and noneoadjuvant therapy, respectively (P<.0001). Patients with a yield of fewer than 12 lymph nodes had improved median overall survival of 43.3 months compared with 36.6 months in patients with 12 or more lymph nodes (P=.009). Multivariate analysis demonstrated that neither node yield nor status were predictors for overall survival. Discussion: This analysis reiterates that nodal yield in rectal cancer is multifactorial, with neoadjuvant therapy being a significant factor. Node yield and status were not significant predictors of overall survival. A nodal metric may not be clinically relevant in the era of neoadjuvant therapy, and guidelines for perioperative therapy may need reconsideration.

Original languageEnglish (US)
Pages (from-to)1528-1534
Number of pages7
JournalJNCCN Journal of the National Comprehensive Cancer Network
Volume14
Issue number12
DOIs
StatePublished - Dec 1 2016

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Neoadjuvant Therapy
Rectal Neoplasms
Lymph Nodes
Survival
Drug Therapy
Therapeutics
Multivariate Analysis
Neoplasm Staging
Colonic Neoplasms
Databases
Guidelines

ASJC Scopus subject areas

  • Oncology

Cite this

Abdel-Misih, Sherif R.Z. ; Wei, Lai ; Benson III, Al B ; Cohen, Steven ; Lai, Lily ; Skibber, John ; Wilkinson, Neal ; Weiser, Martin ; Schrag, Deborah ; Bekaii-Saab, Tanios. / Neoadjuvant therapy for rectal cancer affects lymph node yield and status without clear implications on outcome : The case for eliminating a metric and using preoperative staging to guide therapy. In: JNCCN Journal of the National Comprehensive Cancer Network. 2016 ; Vol. 14, No. 12. pp. 1528-1534.
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Neoadjuvant therapy for rectal cancer affects lymph node yield and status without clear implications on outcome : The case for eliminating a metric and using preoperative staging to guide therapy. / Abdel-Misih, Sherif R.Z.; Wei, Lai; Benson III, Al B; Cohen, Steven; Lai, Lily; Skibber, John; Wilkinson, Neal; Weiser, Martin; Schrag, Deborah; Bekaii-Saab, Tanios.

In: JNCCN Journal of the National Comprehensive Cancer Network, Vol. 14, No. 12, 01.12.2016, p. 1528-1534.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Neoadjuvant therapy for rectal cancer affects lymph node yield and status without clear implications on outcome

T2 - The case for eliminating a metric and using preoperative staging to guide therapy

AU - Abdel-Misih, Sherif R.Z.

AU - Wei, Lai

AU - Benson III, Al B

AU - Cohen, Steven

AU - Lai, Lily

AU - Skibber, John

AU - Wilkinson, Neal

AU - Weiser, Martin

AU - Schrag, Deborah

AU - Bekaii-Saab, Tanios

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Background: Nodal status has long been considered pivotal to oncologic care, staging, and management. This has resulted in the establishment of rudimentary metrics regarding adequate lymph node yield in colon and rectal cancers for accurate cancer staging. In the era of neoadjuvant treatment, the implications of lymph node yield and status on patient outcomes remains unclear. Patient and Methods: This study included 1,680 patients with locally advanced rectal cancer from the NCCN prospective oncology database stratified into 3 groups based on preoperative therapy received: no neoadjuvant therapy, neoadjuvant chemoradiation, and neoadjuvant chemotherapy. Clinicopathologic characteristics and survival were compared between the groups, with univariate and multivariate analyses undertaken. Results: The clinicopathologic characteristics demonstrated statistically significant differences and heterogeneity among the 3 groups. The neoadjuvant chemoradiation group demonstrated the statistically lowest median lymph node yield (n=15) compared with 17 and 18 for no-neoadjuvant and neoadjuvant chemotherapy, respectively (P<.0001). Neoadjuvant treatment did impact survival, with chemoradiation demonstrating increased median overall survival of 42.7 compared with 37.3 and 26.6 months for neoadjuvant chemotherapy and noneoadjuvant therapy, respectively (P<.0001). Patients with a yield of fewer than 12 lymph nodes had improved median overall survival of 43.3 months compared with 36.6 months in patients with 12 or more lymph nodes (P=.009). Multivariate analysis demonstrated that neither node yield nor status were predictors for overall survival. Discussion: This analysis reiterates that nodal yield in rectal cancer is multifactorial, with neoadjuvant therapy being a significant factor. Node yield and status were not significant predictors of overall survival. A nodal metric may not be clinically relevant in the era of neoadjuvant therapy, and guidelines for perioperative therapy may need reconsideration.

AB - Background: Nodal status has long been considered pivotal to oncologic care, staging, and management. This has resulted in the establishment of rudimentary metrics regarding adequate lymph node yield in colon and rectal cancers for accurate cancer staging. In the era of neoadjuvant treatment, the implications of lymph node yield and status on patient outcomes remains unclear. Patient and Methods: This study included 1,680 patients with locally advanced rectal cancer from the NCCN prospective oncology database stratified into 3 groups based on preoperative therapy received: no neoadjuvant therapy, neoadjuvant chemoradiation, and neoadjuvant chemotherapy. Clinicopathologic characteristics and survival were compared between the groups, with univariate and multivariate analyses undertaken. Results: The clinicopathologic characteristics demonstrated statistically significant differences and heterogeneity among the 3 groups. The neoadjuvant chemoradiation group demonstrated the statistically lowest median lymph node yield (n=15) compared with 17 and 18 for no-neoadjuvant and neoadjuvant chemotherapy, respectively (P<.0001). Neoadjuvant treatment did impact survival, with chemoradiation demonstrating increased median overall survival of 42.7 compared with 37.3 and 26.6 months for neoadjuvant chemotherapy and noneoadjuvant therapy, respectively (P<.0001). Patients with a yield of fewer than 12 lymph nodes had improved median overall survival of 43.3 months compared with 36.6 months in patients with 12 or more lymph nodes (P=.009). Multivariate analysis demonstrated that neither node yield nor status were predictors for overall survival. Discussion: This analysis reiterates that nodal yield in rectal cancer is multifactorial, with neoadjuvant therapy being a significant factor. Node yield and status were not significant predictors of overall survival. A nodal metric may not be clinically relevant in the era of neoadjuvant therapy, and guidelines for perioperative therapy may need reconsideration.

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