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Prognostic Impact of Extranodal Extension in Rectal Cancer Patients Undergoing Radical Resection After Preoperative Chemoradiotherapy

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Abstract
Extranodal extension (ENE) in rectal cancer after preoperative chemoradiotherapy (PCRT) has not been extensively investigated. This study assessed ENE and its prognostic impact in rectal cancer after PCRT. ENE was closely related to advanced tumor stage and poor survival outcome.

Background: Extranodal extension (ENE) of nodal metastasis has emerged as an important prognostic factor in many malignancies, including rectal cancer. However, its significance in patients with rectal cancer receiving preoperative chemoradiotherapy (PCRT) has not been extensively investigated. We therefore assessed ENE and its prognostic impact in a large series of consecutive rectal cancer patients with lymph node metastasis after PCRT and curative resection. Patients and Methods: Between January 2000 and December 2014, a total of 1925 patients with rectal cancer underwent surgical resection after PCRT. Medical records of 469 patients with pathologic node positivity were retrospectively reviewed. Results: Of the 469 patients, 118 (25.2%) presented with ENE. ENE was observed more frequently in those with advanced tumor stage (higher ypT, ypN, and ypStage), lymphovascular invasion, and perineural invasion. Five-year disease-free survival rate was lower in patients with ENE-positive tumors than those with ENE-negative tumors (36.1% vs. 52.3%, P = .003). Similarly, 5-year overall survival rate was lower in patients with ENE-positive tumors than those with ENE-negative tumors (60.2% vs. 70.6%, P < .001). Multivariate analysis revealed that the presence of ENE was an independent poor prognostic factor for disease-free survival (hazard ratio = 1.412; 95% confidence interval, 1.074-1.857; P = .013) and overall survival (hazard ratio = 1.531; 95% confidence interval 1.149-2.039; P = .004). Conclusion: The presence of ENE in patients with rectal cancer undergoing PCRT is a negative prognostic factor, reflecting poor survival outcome.
Author(s)
김영일김지훈김진천김찬욱노준수박양순박인자유창식윤용식이종률임석병조해연
Issued Date
2021
Type
Article
Keyword
ChemoradiotherapyExtranodal extensionLymph nodePrognosisRectal neoplasm
DOI
10.1016/j.clcc.2020.08.004
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7819
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2461003133&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Prognostic%20Impact%20of%20Extranodal%20Extension%20in%20Rectal%20Cancer%20Patients%20Undergoing%20Radical%20Resection%20After%20Preoperative%20Chemoradiotherapy&amp;offset=0&amp;pcAvailability=true
Publisher
CLINICAL COLORECTAL CANCER
Location
미국
Language
영어
ISSN
1533-0028
Citation Volume
20
Citation Number
1
Citation Start Page
35
Citation End Page
42
Appears in Collections:
Medicine > Medicine
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