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Effect of neoadjuvant radiation dose and schedule on nodal count and its prognostic impact in stage II–III rectal cancer

Wim Ceelen UGent, WOUTER WILLAERT, Machteld Varewyck, Sasha Libbrecht, Els Goetghebeur UGent and Piet Pattyn UGent (2016) ANNALS OF SURGICAL ONCOLOGY. 23(12). p.3899-3906
abstract
It is unknown how neoadjuvant treatment schedule affects lymph node count (LNC) and lymph node ratio (LNR) and how these correlate with overall survival (OS) in rectal cancer (RC). Data were used from the Belgian PROCARE rectal cancer registry on RC patients treated with surgery alone, short-term radiotherapy with immediate surgery (SRT), or chemoradiation with deferred surgery (CRT). The effect of neoadjuvant therapy on LNC was examined using Poisson log-linear analysis. The association of LNC and LNR with overall survival (OS) was studied using Cox proportional hazards models. Data from 4037 patients were available. Compared with surgery alone, LNC was reduced by 12.3 % after SRT and by 31.3 % after CRT (p < 0.001). In patients with surgery alone, the probability of finding node-positive disease increased with LNC, while after SRT and CRT no increase was noted for more than 12 and 18 examined nodes, respectively. Per node examined, we found a decrease in hazard of death of 2.7 % after surgery alone and 1.5 % after SRT, but no effect after CRT. In stage III patients, the LNR but not (y)pN stage was significantly correlated with OS regardless of neoadjuvant therapy. Specifically, a LNR > 0.4 was associated with a significantly worse outcome. Nodal counts are reduced in a schedule-dependent manner by neoadjuvant treatment in RC. After chemoradiation, the LNC does not confer any prognostic information. A LNR of > 0.4 is associated with a significantly worse outcome in stage III disease, regardless of neoadjuvant therapy type.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
TOTAL MESORECTAL EXCISION, LYMPH-NODES, PREOPERATIVE CHEMORADIOTHERAPY, COLORECTAL-CANCER, COLON-CANCER, CARCINOMA, NUMBER, SURVIVAL, RATIO, GUIDELINES
journal title
ANNALS OF SURGICAL ONCOLOGY
Ann. Surg. Oncol.
volume
23
issue
12
pages
3899 - 3906
Web of Science type
Article
Web of Science id
000385155900018
JCR category
SURGERY
JCR impact factor
4.041 (2016)
JCR rank
17/196 (2016)
JCR quartile
1 (2016)
ISSN
1068-9265
DOI
10.1245/s10434-016-5363-4
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
8502789
handle
http://hdl.handle.net/1854/LU-8502789
date created
2017-01-18 13:48:52
date last changed
2017-02-07 11:01:21
@article{8502789,
  abstract     = {It is unknown how neoadjuvant treatment schedule affects lymph node count (LNC) and lymph node ratio (LNR) and how these correlate with overall survival (OS) in rectal cancer (RC). 
Data were used from the Belgian PROCARE rectal cancer registry on RC patients treated with surgery alone, short-term radiotherapy with immediate surgery (SRT), or chemoradiation with deferred surgery (CRT). The effect of neoadjuvant therapy on LNC was examined using Poisson log-linear analysis. The association of LNC and LNR with overall survival (OS) was studied using Cox proportional hazards models. 
Data from 4037 patients were available. Compared with surgery alone, LNC was reduced by 12.3 \% after SRT and by 31.3 \% after CRT (p {\textlangle} 0.001). In patients with surgery alone, the probability of finding node-positive disease increased with LNC, while after SRT and CRT no increase was noted for more than 12 and 18 examined nodes, respectively. Per node examined, we found a decrease in hazard of death of 2.7 \% after surgery alone and 1.5 \% after SRT, but no effect after CRT. In stage III patients, the LNR but not (y)pN stage was significantly correlated with OS regardless of neoadjuvant therapy. Specifically, a LNR {\textrangle} 0.4 was associated with a significantly worse outcome. 
Nodal counts are reduced in a schedule-dependent manner by neoadjuvant treatment in RC. After chemoradiation, the LNC does not confer any prognostic information. A LNR of {\textrangle} 0.4 is associated with a significantly worse outcome in stage III disease, regardless of neoadjuvant therapy type.},
  author       = {Ceelen, Wim and WILLAERT, WOUTER and Varewyck, Machteld and Libbrecht, Sasha and Goetghebeur, Els and Pattyn, Piet},
  issn         = {1068-9265},
  journal      = {ANNALS OF SURGICAL ONCOLOGY},
  keyword      = {TOTAL MESORECTAL EXCISION,LYMPH-NODES,PREOPERATIVE CHEMORADIOTHERAPY,COLORECTAL-CANCER,COLON-CANCER,CARCINOMA,NUMBER,SURVIVAL,RATIO,GUIDELINES},
  language     = {eng},
  number       = {12},
  pages        = {3899--3906},
  title        = {Effect of neoadjuvant radiation dose and schedule on nodal count and its prognostic impact in stage II--III rectal cancer},
  url          = {http://dx.doi.org/10.1245/s10434-016-5363-4},
  volume       = {23},
  year         = {2016},
}

Chicago
Ceelen, Wim, WOUTER WILLAERT, Machteld Varewyck, Sasha Libbrecht, Els Goetghebeur, and Piet Pattyn. 2016. “Effect of Neoadjuvant Radiation Dose and Schedule on Nodal Count and Its Prognostic Impact in Stage II–III Rectal Cancer.” Annals of Surgical Oncology 23 (12): 3899–3906.
APA
Ceelen, Wim, WILLAERT, W., Varewyck, M., Libbrecht, S., Goetghebeur, E., & Pattyn, P. (2016). Effect of neoadjuvant radiation dose and schedule on nodal count and its prognostic impact in stage II–III rectal cancer. ANNALS OF SURGICAL ONCOLOGY, 23(12), 3899–3906.
Vancouver
1.
Ceelen W, WILLAERT W, Varewyck M, Libbrecht S, Goetghebeur E, Pattyn P. Effect of neoadjuvant radiation dose and schedule on nodal count and its prognostic impact in stage II–III rectal cancer. ANNALS OF SURGICAL ONCOLOGY. 2016;23(12):3899–906.
MLA
Ceelen, Wim, WOUTER WILLAERT, Machteld Varewyck, et al. “Effect of Neoadjuvant Radiation Dose and Schedule on Nodal Count and Its Prognostic Impact in Stage II–III Rectal Cancer.” ANNALS OF SURGICAL ONCOLOGY 23.12 (2016): 3899–3906. Print.