Number of lymph nodes assessed has no prognostic impact in node-negative rectal cancers after neoadjuvant therapy. Results of the "Italian Society of Surgical Oncology (S.I.C.O.) Colorectal Cancer Network" (SICO-CCN) multicentre collaborative study

Maurizio Degiuli, Simone Arolfo, Andrea Evangelista, Laura Lorenzon, Rossella Reddavid, Carlo Staudacher, Paola De Nardi, Riccardo Rosati, Ugo Elmore, Claudio Coco, Gianluca Rizzo, Claudio Belluco, Marco Forlin, Marco Milone, Giovanni Domenico De Palma, Daniela Rega, Paolo Delrio, Mario Guerrieri, Monica Ortenzi, Andrea MuratorePatrizia Marsanic, Angelo Restivo, Simona Deidda, Matteo Zuin, Salvatore Pucciarelli, Raffaele De Luca, Roberto Persiani, Alberto Biondi, Franco Roviello, Daniele Marrelli, Giovanni Sgroi, Luca Turati, Mario Morino

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: We retrospectively investigated the impact of number or complete absence of nodes retrieved on survival of patients with rectal cancer (RC) treated with neoadjuvant radiation-therapy (NAT).

METHODS: All patients with RC treated with NAT followed by curative surgery from 2000 to 2014 in 14 Italian referral Centres for Colorectal Surgery were enrolled. Information about number of nodes harvested, node ratio, type of radiation therapy schedule and tumour stage were recorded. Impact of number or complete absence of nodes retrieved on overall survival (OS) and on cumulative incidence of death for disease (CIDD) was assessed and factors influencing node yield were investigated.

RESULTS: In total, 1407 patients were included. Mean number of nodes retrieved was 12.9, while no lymph nodes were found in only 32 patients (2%, ypNnull). Definite nodal stage was ypN0 in 1001 patients (71%) and ypN+ in 372 patients (27%). In multivariable analysis ypNnull patients showed worse OS and CIDD compared to both ypN0 and ypN+. In ypN0 patients, number of nodes assessed, stratified in 4 groups (<5, 5-10, 11-15 and > 15), did not significantly influence OS and CIDD. Long-course radiation schedule and early T stages negatively affected node assessment.

CONCLUSION: Complete absence of nodes assessed was associated with worse prognosis compared to node-negative and node-positive patients. In node-negative patients number of nodes was not associated to OS and CIDD. Based on data from this large population of irradiated RC, number of nodes assessed has no prognostic impact in node-negative patients.

Original languageEnglish
Pages (from-to)1233-1240
Number of pages8
JournalEuropean Journal of Surgical Oncology
Volume44
Issue number8
DOIs
Publication statusPublished - Aug 2018

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Neoadjuvant Therapy
Rectal Neoplasms
Multicenter Studies
Colorectal Neoplasms
Lymph Nodes
Survival
Radiotherapy
Incidence
Appointments and Schedules
Colorectal Surgery
Referral and Consultation
Radiation

Keywords

  • Adenocarcinoma/diagnosis
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Digestive System Surgical Procedures/methods
  • Female
  • Follow-Up Studies
  • Humans
  • Lymph Nodes/pathology
  • Male
  • Middle Aged
  • Neoadjuvant Therapy
  • Neoplasm Staging
  • Prognosis
  • Rectal Neoplasms/diagnosis
  • Retrospective Studies
  • Societies, Medical
  • Surgical Oncology
  • Young Adult

Cite this

Number of lymph nodes assessed has no prognostic impact in node-negative rectal cancers after neoadjuvant therapy. Results of the "Italian Society of Surgical Oncology (S.I.C.O.) Colorectal Cancer Network" (SICO-CCN) multicentre collaborative study. / Degiuli, Maurizio; Arolfo, Simone; Evangelista, Andrea; Lorenzon, Laura; Reddavid, Rossella; Staudacher, Carlo; De Nardi, Paola; Rosati, Riccardo; Elmore, Ugo; Coco, Claudio; Rizzo, Gianluca; Belluco, Claudio; Forlin, Marco; Milone, Marco; De Palma, Giovanni Domenico; Rega, Daniela; Delrio, Paolo; Guerrieri, Mario; Ortenzi, Monica; Muratore, Andrea; Marsanic, Patrizia; Restivo, Angelo; Deidda, Simona; Zuin, Matteo; Pucciarelli, Salvatore; De Luca, Raffaele; Persiani, Roberto; Biondi, Alberto; Roviello, Franco; Marrelli, Daniele; Sgroi, Giovanni; Turati, Luca; Morino, Mario.

In: European Journal of Surgical Oncology, Vol. 44, No. 8, 08.2018, p. 1233-1240.

Research output: Contribution to journalArticle

Degiuli, M, Arolfo, S, Evangelista, A, Lorenzon, L, Reddavid, R, Staudacher, C, De Nardi, P, Rosati, R, Elmore, U, Coco, C, Rizzo, G, Belluco, C, Forlin, M, Milone, M, De Palma, GD, Rega, D, Delrio, P, Guerrieri, M, Ortenzi, M, Muratore, A, Marsanic, P, Restivo, A, Deidda, S, Zuin, M, Pucciarelli, S, De Luca, R, Persiani, R, Biondi, A, Roviello, F, Marrelli, D, Sgroi, G, Turati, L & Morino, M 2018, 'Number of lymph nodes assessed has no prognostic impact in node-negative rectal cancers after neoadjuvant therapy. Results of the "Italian Society of Surgical Oncology (S.I.C.O.) Colorectal Cancer Network" (SICO-CCN) multicentre collaborative study', European Journal of Surgical Oncology, vol. 44, no. 8, pp. 1233-1240. https://doi.org/10.1016/j.ejso.2018.04.007
Degiuli, Maurizio ; Arolfo, Simone ; Evangelista, Andrea ; Lorenzon, Laura ; Reddavid, Rossella ; Staudacher, Carlo ; De Nardi, Paola ; Rosati, Riccardo ; Elmore, Ugo ; Coco, Claudio ; Rizzo, Gianluca ; Belluco, Claudio ; Forlin, Marco ; Milone, Marco ; De Palma, Giovanni Domenico ; Rega, Daniela ; Delrio, Paolo ; Guerrieri, Mario ; Ortenzi, Monica ; Muratore, Andrea ; Marsanic, Patrizia ; Restivo, Angelo ; Deidda, Simona ; Zuin, Matteo ; Pucciarelli, Salvatore ; De Luca, Raffaele ; Persiani, Roberto ; Biondi, Alberto ; Roviello, Franco ; Marrelli, Daniele ; Sgroi, Giovanni ; Turati, Luca ; Morino, Mario. / Number of lymph nodes assessed has no prognostic impact in node-negative rectal cancers after neoadjuvant therapy. Results of the "Italian Society of Surgical Oncology (S.I.C.O.) Colorectal Cancer Network" (SICO-CCN) multicentre collaborative study. In: European Journal of Surgical Oncology. 2018 ; Vol. 44, No. 8. pp. 1233-1240.
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title = "Number of lymph nodes assessed has no prognostic impact in node-negative rectal cancers after neoadjuvant therapy. Results of the {"}Italian Society of Surgical Oncology (S.I.C.O.) Colorectal Cancer Network{"} (SICO-CCN) multicentre collaborative study",
abstract = "INTRODUCTION: We retrospectively investigated the impact of number or complete absence of nodes retrieved on survival of patients with rectal cancer (RC) treated with neoadjuvant radiation-therapy (NAT).METHODS: All patients with RC treated with NAT followed by curative surgery from 2000 to 2014 in 14 Italian referral Centres for Colorectal Surgery were enrolled. Information about number of nodes harvested, node ratio, type of radiation therapy schedule and tumour stage were recorded. Impact of number or complete absence of nodes retrieved on overall survival (OS) and on cumulative incidence of death for disease (CIDD) was assessed and factors influencing node yield were investigated.RESULTS: In total, 1407 patients were included. Mean number of nodes retrieved was 12.9, while no lymph nodes were found in only 32 patients (2{\%}, ypNnull). Definite nodal stage was ypN0 in 1001 patients (71{\%}) and ypN+ in 372 patients (27{\%}). In multivariable analysis ypNnull patients showed worse OS and CIDD compared to both ypN0 and ypN+. In ypN0 patients, number of nodes assessed, stratified in 4 groups (<5, 5-10, 11-15 and > 15), did not significantly influence OS and CIDD. Long-course radiation schedule and early T stages negatively affected node assessment.CONCLUSION: Complete absence of nodes assessed was associated with worse prognosis compared to node-negative and node-positive patients. In node-negative patients number of nodes was not associated to OS and CIDD. Based on data from this large population of irradiated RC, number of nodes assessed has no prognostic impact in node-negative patients.",
keywords = "Adenocarcinoma/diagnosis, Adolescent, Adult, Aged, Aged, 80 and over, Digestive System Surgical Procedures/methods, Female, Follow-Up Studies, Humans, Lymph Nodes/pathology, Male, Middle Aged, Neoadjuvant Therapy, Neoplasm Staging, Prognosis, Rectal Neoplasms/diagnosis, Retrospective Studies, Societies, Medical, Surgical Oncology, Young Adult",
author = "Maurizio Degiuli and Simone Arolfo and Andrea Evangelista and Laura Lorenzon and Rossella Reddavid and Carlo Staudacher and {De Nardi}, Paola and Riccardo Rosati and Ugo Elmore and Claudio Coco and Gianluca Rizzo and Claudio Belluco and Marco Forlin and Marco Milone and {De Palma}, {Giovanni Domenico} and Daniela Rega and Paolo Delrio and Mario Guerrieri and Monica Ortenzi and Andrea Muratore and Patrizia Marsanic and Angelo Restivo and Simona Deidda and Matteo Zuin and Salvatore Pucciarelli and {De Luca}, Raffaele and Roberto Persiani and Alberto Biondi and Franco Roviello and Daniele Marrelli and Giovanni Sgroi and Luca Turati and Mario Morino",
note = "Copyright {\circledC} 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.",
year = "2018",
month = "8",
doi = "10.1016/j.ejso.2018.04.007",
language = "English",
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pages = "1233--1240",
journal = "European Journal of Surgical Oncology",
issn = "0748-7983",
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}

TY - JOUR

T1 - Number of lymph nodes assessed has no prognostic impact in node-negative rectal cancers after neoadjuvant therapy. Results of the "Italian Society of Surgical Oncology (S.I.C.O.) Colorectal Cancer Network" (SICO-CCN) multicentre collaborative study

AU - Degiuli, Maurizio

AU - Arolfo, Simone

AU - Evangelista, Andrea

AU - Lorenzon, Laura

AU - Reddavid, Rossella

AU - Staudacher, Carlo

AU - De Nardi, Paola

AU - Rosati, Riccardo

AU - Elmore, Ugo

AU - Coco, Claudio

AU - Rizzo, Gianluca

AU - Belluco, Claudio

AU - Forlin, Marco

AU - Milone, Marco

AU - De Palma, Giovanni Domenico

AU - Rega, Daniela

AU - Delrio, Paolo

AU - Guerrieri, Mario

AU - Ortenzi, Monica

AU - Muratore, Andrea

AU - Marsanic, Patrizia

AU - Restivo, Angelo

AU - Deidda, Simona

AU - Zuin, Matteo

AU - Pucciarelli, Salvatore

AU - De Luca, Raffaele

AU - Persiani, Roberto

AU - Biondi, Alberto

AU - Roviello, Franco

AU - Marrelli, Daniele

AU - Sgroi, Giovanni

AU - Turati, Luca

AU - Morino, Mario

N1 - Copyright © 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

PY - 2018/8

Y1 - 2018/8

N2 - INTRODUCTION: We retrospectively investigated the impact of number or complete absence of nodes retrieved on survival of patients with rectal cancer (RC) treated with neoadjuvant radiation-therapy (NAT).METHODS: All patients with RC treated with NAT followed by curative surgery from 2000 to 2014 in 14 Italian referral Centres for Colorectal Surgery were enrolled. Information about number of nodes harvested, node ratio, type of radiation therapy schedule and tumour stage were recorded. Impact of number or complete absence of nodes retrieved on overall survival (OS) and on cumulative incidence of death for disease (CIDD) was assessed and factors influencing node yield were investigated.RESULTS: In total, 1407 patients were included. Mean number of nodes retrieved was 12.9, while no lymph nodes were found in only 32 patients (2%, ypNnull). Definite nodal stage was ypN0 in 1001 patients (71%) and ypN+ in 372 patients (27%). In multivariable analysis ypNnull patients showed worse OS and CIDD compared to both ypN0 and ypN+. In ypN0 patients, number of nodes assessed, stratified in 4 groups (<5, 5-10, 11-15 and > 15), did not significantly influence OS and CIDD. Long-course radiation schedule and early T stages negatively affected node assessment.CONCLUSION: Complete absence of nodes assessed was associated with worse prognosis compared to node-negative and node-positive patients. In node-negative patients number of nodes was not associated to OS and CIDD. Based on data from this large population of irradiated RC, number of nodes assessed has no prognostic impact in node-negative patients.

AB - INTRODUCTION: We retrospectively investigated the impact of number or complete absence of nodes retrieved on survival of patients with rectal cancer (RC) treated with neoadjuvant radiation-therapy (NAT).METHODS: All patients with RC treated with NAT followed by curative surgery from 2000 to 2014 in 14 Italian referral Centres for Colorectal Surgery were enrolled. Information about number of nodes harvested, node ratio, type of radiation therapy schedule and tumour stage were recorded. Impact of number or complete absence of nodes retrieved on overall survival (OS) and on cumulative incidence of death for disease (CIDD) was assessed and factors influencing node yield were investigated.RESULTS: In total, 1407 patients were included. Mean number of nodes retrieved was 12.9, while no lymph nodes were found in only 32 patients (2%, ypNnull). Definite nodal stage was ypN0 in 1001 patients (71%) and ypN+ in 372 patients (27%). In multivariable analysis ypNnull patients showed worse OS and CIDD compared to both ypN0 and ypN+. In ypN0 patients, number of nodes assessed, stratified in 4 groups (<5, 5-10, 11-15 and > 15), did not significantly influence OS and CIDD. Long-course radiation schedule and early T stages negatively affected node assessment.CONCLUSION: Complete absence of nodes assessed was associated with worse prognosis compared to node-negative and node-positive patients. In node-negative patients number of nodes was not associated to OS and CIDD. Based on data from this large population of irradiated RC, number of nodes assessed has no prognostic impact in node-negative patients.

KW - Adenocarcinoma/diagnosis

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Digestive System Surgical Procedures/methods

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Lymph Nodes/pathology

KW - Male

KW - Middle Aged

KW - Neoadjuvant Therapy

KW - Neoplasm Staging

KW - Prognosis

KW - Rectal Neoplasms/diagnosis

KW - Retrospective Studies

KW - Societies, Medical

KW - Surgical Oncology

KW - Young Adult

U2 - 10.1016/j.ejso.2018.04.007

DO - 10.1016/j.ejso.2018.04.007

M3 - Article

C2 - 29705284

VL - 44

SP - 1233

EP - 1240

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

SN - 0748-7983

IS - 8

ER -