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The impact of pathologic nodal status on survival following neoadjuvant chemoradiation for locally advanced rectal cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

For patients with locally advanced rectal cancer, the accuracy rates of preneoadjuvant therapy nodal staging and potential nodal downstaging make the prognostic significance of nodal status unclear. We therefore sought to review our experience in order to better understand the impact of clinical and pathologic nodal status upon patient outcomes.

Methods

174 patients were identified as having undergone neoadjuvant chemoradiation and resection for rectal cancer. For analytic purposes, patients were grouped into four nodal categories (uN 0· pN 0, uN 0· pN +, uN + · pN 0, and uN + · pN +). Univariate and multivariate analyses were performed.

Results

104 men and 70 women of median age 60 years (29–85 years) were followed for a median of 31 months (1–121 months). Nodal staging was available for 129 patients, with a median of 8 lymph nodes (range 0–39) evaluated. Disease recurred in 3 of 41 (7 %) uN   0·pN   0, 10 of 52 (20 %) uN    +·pN   0, 7 of 18 (41 %) uN   0·pN    +, and 6 of 17 (35 %) uN   +·pN   + patients. Those patients having nodal downstaging (uN   +·pN   0) experienced superior overall survival (p = 0.03). Only pathologic nodal status was a significant predictor of both disease-free and overall survival in multivariate modeling. Adjuvant chemotherapy did not impact disease-free or overall survival for patients with pN0.

Conclusions

Pathologic nodal status may represent a superior predictor of survival for patients with local advanced rectal cancers. Our findings may have potential implications for the application of adjuvant therapy.

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Acknowledgments

This work was funded in part by the Moffitt TJF Colorectal Cancer Research Fund.

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Authors and Affiliations

  1. Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    Jonathan M. Hernandez, Whalen Clark, Jill Weber, Lauren Lange & David Shibata

  2. Biostatistics Core, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    William J. Fulp

Authors
  1. Jonathan M. Hernandez
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  2. Whalen Clark
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  3. Jill Weber
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  4. William J. Fulp
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  5. Lauren Lange
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  6. David Shibata
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Correspondence to David Shibata.

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Hernandez, J.M., Clark, W., Weber, J. et al. The impact of pathologic nodal status on survival following neoadjuvant chemoradiation for locally advanced rectal cancer. Int J Colorectal Dis 29, 1061–1068 (2014). https://doi.org/10.1007/s00384-014-1917-8

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  • DOI: https://doi.org/10.1007/s00384-014-1917-8

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