Dakui Luo, Zhen Wang, Yufei Yang, Qingguo Li, Xinxiang Li
{"title":"Prognostic value of residual lymph node status in patients with pathological T0 rectal cancer after neoadjuvant therapy.","authors":"Dakui Luo, Zhen Wang, Yufei Yang, Qingguo Li, Xinxiang Li","doi":"10.1177/17562848251340494","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>A yield pathological T0 (ypT0) classification usually indicates the pathologically complete response of rectal cancer to neoadjuvant therapy. However, lymph node metastasis may still be present.</p><p><strong>Objectives: </strong>In this study, we aimed to evaluate the prognostic value of residual lymph node status in patients with pathological T0 rectal cancer after neoadjuvant therapy.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>Patients with locally advanced rectal cancer (LARC) who had undergone preoperative therapy and were pathologically classified as having ypT0 disease at Fudan University Shanghai Cancer Center between December 2012 and September 2022 were retrospectively analyzed. Uni- and multivariate analyses were performed to evaluate the effect of the residual lymph node status on disease-free survival (DFS) and overall survival (OS).</p><p><strong>Results: </strong>A total of 457 patients had ypT0 disease; this included 413 patients with ypT0N0 and 44 with ypT0N1-2. Inadequate lymph node retrieval (<12, <i>p</i> = 0.002) and adenocarcinoma (<i>p</i> = 0.009) were more common in the ypT0N0 group than in the ypT0N1-2 group. The ypT0N1-2 group showed marginal evidence of a higher probability of elevated pretreatment carcinoembryonic antigen levels and adjuvant chemotherapy than the ypT0N0 group (<i>p</i> = 0.076 and <i>p</i> = 0.077, respectively). Patients with ypT0N0 had significantly better 5-year DFS than those with ypT0N1-2 (84.8% vs 68.4%, <i>p</i> = 0.016). However, no significant difference was observed in the 5-year OS between the two groups (93.9% vs 88.8%, <i>p</i> = 0.602). Multivariate analysis revealed that residual lymph node status was an independent prognostic factor for DFS (hazard ratio, 2.285; 95% confidence interval: 1.246-4.192, <i>p</i> = 0.008).</p><p><strong>Conclusion: </strong>Residual lymph node metastasis may affect DFS, but not OS, in pathological T0 patients who receive neoadjuvant therapy followed by radical surgery for LARC.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251340494"},"PeriodicalIF":3.9000,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12099127/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Therapeutic Advances in Gastroenterology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/17562848251340494","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: A yield pathological T0 (ypT0) classification usually indicates the pathologically complete response of rectal cancer to neoadjuvant therapy. However, lymph node metastasis may still be present.
Objectives: In this study, we aimed to evaluate the prognostic value of residual lymph node status in patients with pathological T0 rectal cancer after neoadjuvant therapy.
Design: Retrospective cohort study.
Methods: Patients with locally advanced rectal cancer (LARC) who had undergone preoperative therapy and were pathologically classified as having ypT0 disease at Fudan University Shanghai Cancer Center between December 2012 and September 2022 were retrospectively analyzed. Uni- and multivariate analyses were performed to evaluate the effect of the residual lymph node status on disease-free survival (DFS) and overall survival (OS).
Results: A total of 457 patients had ypT0 disease; this included 413 patients with ypT0N0 and 44 with ypT0N1-2. Inadequate lymph node retrieval (<12, p = 0.002) and adenocarcinoma (p = 0.009) were more common in the ypT0N0 group than in the ypT0N1-2 group. The ypT0N1-2 group showed marginal evidence of a higher probability of elevated pretreatment carcinoembryonic antigen levels and adjuvant chemotherapy than the ypT0N0 group (p = 0.076 and p = 0.077, respectively). Patients with ypT0N0 had significantly better 5-year DFS than those with ypT0N1-2 (84.8% vs 68.4%, p = 0.016). However, no significant difference was observed in the 5-year OS between the two groups (93.9% vs 88.8%, p = 0.602). Multivariate analysis revealed that residual lymph node status was an independent prognostic factor for DFS (hazard ratio, 2.285; 95% confidence interval: 1.246-4.192, p = 0.008).
Conclusion: Residual lymph node metastasis may affect DFS, but not OS, in pathological T0 patients who receive neoadjuvant therapy followed by radical surgery for LARC.
期刊介绍:
Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area.
The editors welcome original research articles across all areas of gastroenterology and hepatology.
The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.