Impact of lymph node ratio and number on survival in patients with rectal adenocarcinoma after preoperative chemo radiation

• DOI: 10.1016/j.ijsu.2014.11.038
• Publication Date: 2014-12-02T03:32:06Z
• Authors: Abu Bakar Hafeez ...; Ali Akbar; Aqsa Hafeez; Aamir Ali Syed; Shahid Khattak; Arif Jamshed; Ather Saeed Kazmi
• Keywords: Adult; Male; Adenocarcinoma; Proctoscopy; Disease-Free Survival; 03 medical and health sciences; 0302 clinical medicine; Humans; Aged; Neoplasm Staging; Proportional Hazards Models; Rectal Neoplasms; Rectum; Chemoradiotherapy; Middle Aged; Prognosis; 3. Good health; Treatment Outcome; Lymphatic Metastasis; Multivariate Analysis; Lymph Node Excision; Surgery; Female; Lymph Nodes

Retrieval of <12 lymph nodes after proctectomy and preoperative chemoradiation (C-XRT) may improve survival in good risk patients. The objective of this study was to determine impact of <12 retrieved lymph nodes and lymph node ratio (LNR) on survival in a population with certain poor prognostic features for rectal cancer.Patients who underwent surgery for rectal adenocarcinoma between 2005 and 2011 were divided them into <12 or >12 lymph node groups. The LNR groups were based on interquartile range. Clinicopathological and treatment outcomes were compared. Expected 5 year disease free and overall survival was calculated. Cox proportional hazard model was used to determine independent predictors.More patients in <12 lymph nodes removed group had low tumors (<5 cm from anal verge) (75.5% versus 60.7%) (P=0.03) and underwent abdominoperineal resection (59.1% versus 42.9%) (P=0.02). Overall survival (OS) and disease free survival (DFS) was not different [(56% and 52% (P=0.7)] [(50% and 57% (P=0.5)]. LNR<0.15 was independent predictor of DFS while LNR ratio<0.12 for OS on multivariate analysis.LNR and not number of retrieved nodes impacts survival in younger patients with predominance of anorectal tumors after C-XRT. A specific LNR cutoff remains to be defined.