Display options
Cite
Inoue Y, Saigusa S, Hiro J, et al. Clinical significance of enlarged lateral pelvic lymph nodes before and after preoperative chemoradiotherapy for rectal cancer. Mol Clin Oncol. 2016;4(6):994-1002doi: 10.3892/mco.2016.855.
Inoue, Y., Saigusa, S., Hiro, J., Toiyama, Y., Araki, T., Tanaka, K., Mohri, Y., & Kusunoki, M. (2016). Clinical significance of enlarged lateral pelvic lymph nodes before and after preoperative chemoradiotherapy for rectal cancer. Molecular and clinical oncology, 4(6), 994-1002. https://doi.org/10.3892/mco.2016.855
Inoue, Yasuhiro, et al. "Clinical significance of enlarged lateral pelvic lymph nodes before and after preoperative chemoradiotherapy for rectal cancer." Molecular and clinical oncology vol. 4,6 (2016): 994-1002. doi: https://doi.org/10.3892/mco.2016.855
Inoue Y, Saigusa S, Hiro J, Toiyama Y, Araki T, Tanaka K, Mohri Y, Kusunoki M. Clinical significance of enlarged lateral pelvic lymph nodes before and after preoperative chemoradiotherapy for rectal cancer. Mol Clin Oncol. 2016 Jun;4(6):994-1002. doi: 10.3892/mco.2016.855. Epub 2016 Apr 08. PMID: 27313860; PMCID: PMC4888032.
Copy Download .nbib Format: NLM
Share it on

Mol Clin Oncol. 2016 Jun;4(6):994-1002. doi: 10.3892/mco.2016.855. Epub 2016 Apr 08.

Clinical significance of enlarged lateral pelvic lymph nodes before and after preoperative chemoradiotherapy for rectal cancer.

Molecular and clinical oncology

Yasuhiro Inoue, Susumu Saigusa, Junichiro Hiro, Yuji Toiyama, Toshimitsu Araki, Koji Tanaka, Yaushiko Mohri, Masato Kusunoki

Affiliations

  1. Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Mie 514-8507, Japan.

PMID: 27313860 PMCID: PMC4888032 DOI: 10.3892/mco.2016.855

Abstract

Preoperative chemoradiotherapy (CRT) with total mesorectal excision (TME) is the widely accepted treatment for rectal cancer (RC) in Western countries. However, there remains controversy as to whether preoperative CRT is useful in tumors that extend beyond the mesorectum, including metastasis to the lateral pelvic lymph nodes (LPLN). The aim of this study was to assess the prognostic significance of LPLN enlargement in patients with RC who receive preoperative CRT followed by TME without LPLN dissection. We evaluated the prognostic effect of radiographic LPLN enlargement before and after CRT, as well as the patients' clinicopathological and genetic profiles. Of the 104 patients investigated, pretreatment imaging identified 19 (18%) as LPLN-positive (>7 mm in diameter). Of these 19 patients, 7 (37%) exhibited LPLN downsizing to <7 mm following CRT. The median follow-up period was 52 months. The 5-year cancer-specific survival (CSS) or relapse-free survival (RFS) did not differ significantly between patients who did and those who did not have positive LPLN on pretreatment imaging. However, LPLN that remained positive after CRT were significantly associated with poorer 5-year CSS (73 vs. 84%, respectively; P=0.0052) and RFS (32 vs. 78%, respectively; P=0.0264). None of the patients whose LPLN were downsized to <7 mm following CRT developed recurrence; however, those with positive LPLN after CRT had a 55% higher recurrence rate, characterized by delayed local recurrence, a pattern that may be affected by certain chemokines. In conclusion, changes in initially positive LPLN (>7 mm) may predict the prognosis of patients with RC who receive preoperative CRT-TME. LPLN positivity after CRT was associated with shorter CSS and RFS. Strategies to improve patient survival may include selective LPLN dissection or more aggressive multimodality therapy.

Keywords: lateral pelvic lymph nodes; preoperative chemoradiotherapy; rectal cancer

References

  1. Dis Colon Rectum. 2009 Apr;52(4):567-76 - PubMed
  2. J Clin Oncol. 2005 Apr 20;23(12):2744-53 - PubMed
  3. Ann Surg Oncol. 2014 Jan;21(1):189-96 - PubMed
  4. Oncol Rep. 2012 Sep;28(3):855-61 - PubMed
  5. Br J Surg. 2005 Jun;92(6):756-63 - PubMed
  6. Int J Colorectal Dis. 2013 Dec;28(12):1667-74 - PubMed
  7. Dis Colon Rectum. 2006 Nov;49(11):1663-72 - PubMed
  8. Blood. 2002 Apr 15;99(8):2703-11 - PubMed
  9. Mol Clin Oncol. 2013 May;1(3):511-516 - PubMed
  10. J Natl Compr Canc Netw. 2012 Dec 1;10(12):1528-64 - PubMed
  11. Br J Surg. 2007 Aug;94(8):1014-9 - PubMed
  12. Br J Surg. 2013 Jul;100(8):1009-14 - PubMed
  13. J Surg Oncol. 2012 Nov;106(6):653-8 - PubMed
  14. Nature. 2001 Mar 1;410(6824):50-6 - PubMed
  15. J Gastrointest Surg. 2011 Aug;15(8):1368-74 - PubMed
  16. Ann Surg. 2007 Jan;245(1):80-7 - PubMed
  17. Surgery. 2002 Jul;132(1):27-33 - PubMed
  18. Clin Cancer Res. 2006 May 1;12(9):2795-803 - PubMed
  19. Cancer Res. 2001 Feb 1;61(3):1029-37 - PubMed
  20. World J Surg. 1997 Sep;21(7):728-32 - PubMed
  21. Ann Surg Oncol. 2010 Aug;17(8):2051-8 - PubMed
  22. Ann Surg. 2012 Jun;255(6):1129-34 - PubMed
  23. Cancer. 1996 Nov 1;78(9):1871-80 - PubMed
  24. Ann Surg Oncol. 2009 Sep;16(9):2645-53 - PubMed

Publication Types