Volume 3, Issue 6, December 2015, Page: 71-76
Prognostic Value of Negative Lymph Nodes (NLN) in Rectal Adenocarcinoma
Amir A. Fikry, Departement of General Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Niveen A. Abo-Touk, Departement of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Received: Nov. 10, 2015;       Accepted: Nov. 19, 2015;       Published: Dec. 10, 2015
DOI: 10.11648/j.js.20150306.14      View  3878      Downloads  62
We studied the impact on prognosis by negative LN (NLN) harvest count on rectal cancer patients, using immunohistochemistry to exclude micrometastasis in nodes negative by hematoxylin and eosin (H & E) stain. A prospective study including 114 patients in Mansoura university hospitals between 2005-2008 aged 18 years or older who were diagnosed as having localized invasive adenocarcinoma rectum with stage I, II & III was conducted. Close follow up done in both surgery department and department of clinical oncology and nuclear medicine for 5 years. We examined patient survival in relation to the negative lymph node count. Our results revealed that the number of negative lymph nodes could affect significantly survival curves where the disease free survival and overall survival were significantly better among the group of patients with more than ten negative LNs (P=0.021 & 0.012 respectively). In conclusion, the negative lymph node count is associated with improved survival of rectal cancer patients.
Rectal Cancer, Negative LN, Survival
To cite this article
Amir A. Fikry, Niveen A. Abo-Touk, Prognostic Value of Negative Lymph Nodes (NLN) in Rectal Adenocarcinoma, Journal of Surgery. Vol. 3, No. 6, 2015, pp. 71-76. doi: 10.11648/j.js.20150306.14
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Alexander J, Watanabe T, Wu TT, Rashid A, Li S, Hamilton SR. Histopathological identification of colon cancer with microsatellite instability. Am J Pathol. 2001; 158: 527–535.
Baxter NN, Virnig DJ, Rothenberger DA, Morris AM, Jessurun J, Virnig BA. Lymph node evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst. 2005; 97: 219–225.
Bilimoria KY, Bentrem DJ, Stewart AK, et al. Lymph node evaluation as a colon cancer quality measure: a national hospital report card. J Natl Cancer Inst 2008; 100: 1310–7.
Bui L, Rempel E, Reeson D, et al. Lymph node counts, rates of positive lymph nodes, and patient survival for colon cancer surgery in Ontario, Canada: a population-based study. J SurgOncol 2006; 93: 439-45.
Chang GJ, Rodriguez-Bigas MA, Skibber JM, et al. Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst 2007; 99:433–41.
Chen Y, Zhang L, Tian J, Ren X, Hao Q. Combining the negative lymph nodes count with the ratio of positive and removed lymph nodes can better predict the postoperative survival in cervical cancer patients. Cancer Cell Int. 2013; 13:6.
Choi H, Law W, Poon J. The optimal number of lymph nodes examined in stage II colorectal cancer and impact of on outcomes. BMC Cancer [Internet] 2010 [cited 2012]; 10:[about 9 p.]. Available online: http://www. biomedcentral.com/1471-2407/10/267
Compton C, Fielding L, Burgart L, et al. Prognostic factors in colorectal cancer: College of American Pathologists consensus statement 1999. Arch Pathol Lab Med 2000; 124: 979-94.
Curtin K, Slattery ML, Holubkov R, et al. p53 alterations in colon tumours: a comparison of SSCP/ sequencing and immunohistochemistry. Appl Immunohistochem Mol Morphol 2004; 12: 380–6.
Cutait R, Alves AVF, Lopes LC, et al. Restaging of colorectal cancer based on the identification of lymph node micrometastases through immunoperoxidase staining of CEA and cytokeratins. Dis Colon Rectum 1991; 34: 917.
Damin DC, Rosito MA, Contu PC, Tarta C, Ferreira PR, Kliemann LM, Schwartsmann G. Lymph node retrieval after preoperative chemoradiotherapy for rectal cancer. J Gastrointest Surg. 2012; 16: 1573–1580.
de Campos-Lobato LF, Stocchi L, de Sousa JB, Buta M, Lavery IC, Fazio VW, Dietz DW, Kalady MF. Less than 12 nodes in the surgical specimen after total mesorectal excision following neoadjuvant chemoradiation: it means more than you think!. Ann SurgOncol. 2013; 20: 3398–3406.
Deng J, Liang H, Wang D, Sun D, Ding X, Pan Y, Liu X. Enhancement the prediction of postoperative survival in gastric cancer by combining the negative lymph node count with ratio between positive and examined lymph nodes. Ann SurgOncol. 2010; 17: 1043–1051.
Fokas E, Liersch T, Fietkau R, Hohenberger W, Beissbarth T, Hess C, Becker H, Ghadimi M, Mrak K, Merkel S, Raab HR, Sauer R, Wittekind C, Rodel C. Tumour Regression Grading After Preoperative Chemoradiotherapy for Locally Advanced Rectal Carcinoma Revisited: Updated Results of the CAO/ARO/AIO-94 Trial. J ClinOncol. 2014; 32: 1554–1562.
George S, Primrose J, Talbot R, Smith J, Mullee M, Bailey D, du Boulay C, Jordan H. Will Rogers revisited: prospective observational study of survival of 3592 patients with colorectal cancer according to number of nodes examined by pathologists. Br J Cancer. 2006; 95: 841–847.
Gunderson LL, Jessup JM, Sargent DJ, Greene FL, Stewart A. Revised tumour and node categorization for rectal cancer based on surveillance, epidemiology, and end results and rectal pooled analysis outcomes. J ClinOncol. 2010; 28:256–263.
Gunderson LL, Jessup JM, Sargent DJ, Greene FL, Stew-art AK. Revised TN categorization for colon cancer basedon national survival outcomes data. J ClinOncol 2010; 28: 264-271.
Havenga K, Enker WE, Norstein J, et al. Improved survival and local control after total mesorectal excision or D3 lymphadenectomy in the treatment of primary rectal cancer. Eur J SurgOncol 1999; 25: 368.
Jass JR, Do KA, Simms LA, Iino H, Wynter C, Pillay SP, Searle J, Radford-Smith G, Young J, Leggett B. Morphology of sporadic colorectal cancer with DNA replication errors. Gut. 1998; 42: 673–679.
Johnson PM, Porter GA, Ricciardi R, Baxter NN. Increasing negative lymph node count is independently associated with improved long-term survival in stage IIIB and IIIC colon cancer. J ClinOncol. 2006; 24: 3570–3575.
Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van Krieken JH, Leer JW, van de Velde CJ. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001; 345: 638–646.
Laura J. Denham, Justin C. Kerstetter, Paul C. Herrmann The complexity of the count: considerations regarding lymph node evaluation in colorectal carcinoma. J Gastrointest Oncol 2012; 3(4): 342-352.
Le Voyer TE, Sigurdson ER, Hanlon AL, Mayer RJ, Macdonald JS, Catalano PJ, Haller DG. Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT- 0089. J ClinOncol. 2003; 21: 2912–2919.
Li QG, Li DW, Zhuo CH, Cai GX, Cai SJ. Metastatic lymph node ratio can further stratify prognosis in rectal cancer patients treated with preoperative radiotherapy: a population-based analysis. Tumour Biol. 2014.
Liefers GJ, Cleton-Jansen AM, van de Velde CJ, et al. Micrometastases and survival in stage II colorectal cancer. N Engl J Med 1998; 339: 223-8.
Lips D, Koebrugge B, Liefers G, et al. The influence of micrometastases on prognosis and survival in stage I-II colon cancer patients: the Enroute+ study. BMC Surgery [Internet] 2011 [cited 2012]; 11:[about 9 p.]. Available online.
Maurer CA, Renzulli P, Meyer JD, Buchler MW. Rectal carcinoma. Optimizing therapy by partial or total mesorectum removal. ZentralblChir 1999; 124 (5): 428-35.
Morris M, Platell C, Iacopetta B. Tumour-infiltrating lymphocytes and perforation in colon cancer predict positive response to 5-fluorouracil chemotherapy. Clin Cancer Res. 2008; 14: 1413–1417.
Ogino S, Brahmandam M, kawasaki T, et al. Combined analysis of COX-2 and p53 expressions reveals synergistic inverse correlations with microsatellite instability and CpG island methylator phenotype in colorectal cancer. Neoplasia 2006; 8: 458–64.
Ogino S, Kawasaki T, Nosho K, et al. LINE-1 hypomethylation is inversely associated with microsatellite instability and CpGmethylator phenotype in colorectal cancer. Int J Cancer 2008; 122: 2767–73.
Pages F, Galon J, Fridman WH. The essential role of the in situ immune reaction in human colorectal cancer. J Leukoc Biol. 2008; 84: 981–987.
Parsons HM, Tuttle TM, Kuntz KM, et al. Association between lymph node evaluation for colon cancer and node positivity over the past 20 years. JAMA 2011; 306: 1089-97.
Popat S, Hubner R, Houlston RS. Systematic review of microsatellite instability and colorectal cancer prognosis. J ClinOncol. 2005; 23: 609–618.
Qingguo Li, Changhua Zhuo, GuoxiangCai, Dawei Li, Lei Liang, Sanjun Cai .Increased number of negative lymph nodes is associated with improved cancer specific survival in pathological IIIB and IIIC rectal cancer treated with preoperative radiotherapy Oncotarget, 2014; 5 (23): 12459-12471.
Rahbari NN, Bork U, Motschall E, Thorlund K, Buchler MW, Koch M, Weitz J. Molecular detection of tumour cells in regional lymph nodes is associated with disease recurrence and poor survival in node-negative colorectal cancer: a systematic review and meta-analysis. J ClinOncol. 2012; 30: 60–70.
Ratto C, Sofo L, Ippoliti M, et al. Accurate lymph-node detection in colorectal specimens resected for cancer is of prognostic significance. Dis Colon Rectum 1999; 42: 143- 54; discussion 154-8.
Rodel C, Martus P, Papadoupolos T, Fuzesi L, Klimpfinger M, Fietkau R, Liersch T, Hohenberger W, Raab R, Sauer R, Wittekind C. Prognostic significance of tumour regression after preoperative chemoradiotherapy for rectal cancer. J ClinOncol. 2005; 23: 8688–8696.
Rullier A, Laurent C, Capdepont M, Vendrely V, Belleannee G, Bioulac-Sage P, Rullier E. Lymph nodes after preoperative chemoradiotherapy for rectal carci¬noma: number, status, and impact on survival. Am J SurgPathol. 2008; 32: 45–50.
San-Gang Wu, Jia-Yuan Sun, Juan Zhou, Feng-Yan Li, Qin Lin, Huan-Xin Lin, Xun-Xing Guan and Zhen-Yu He .Number of negative lymph nodes is associated with disease-free survival in patients with breast cancer BMC Cancer (2015) 15:43.
Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004; 351: 1731–1740.
Shuji Ogino, Katsuhiko Nosho, NatsumiIrahara, Kaori Shima, Yoshifumi Baba, Gregory J etal. Negative Lymph Node Count Is Associated With Survival of Colorectal Cancer Patients, Independent of Tumoural Molecular Alterations and Lymphocytic Reaction. Am J Gastroenterol. 2010; 105(2): 420–433.
Taflampas P, Christodoulakis M, Gourtsoyianni S, Leventi K, Melissas J, Tsiftsis DD. The effect of pre¬operative chemoradiotherapy on lymph node harvest after total mesorectal excision for rectal cancer. Dis Colon Rectum. 2009; 52: 1470–1474.
Vecchio FM, Valentini V, Minsky BD, Padula GD, Venkatraman ES, Balducci M, Micciche F, Ricci R, Morganti AG, Gambacorta MA, Maurizi F, Coco C. The relationship of pathologic tumour regression grade (TRG) and outcomes after preoperative therapy in rectal cancer. Int J Radiat Oncol Biol Phys. 2005; 62: 752–760.
Wichmann MW, Muller C, Meyer G, Strauss T, Hornung HM, Lau-Werner U, Angele MK, Schildberg FW. Effect of preoperative radiochemotherapy on lymph node retrieval after resection of rectal cancer. Arch Surg. 2002; 137: 206–210.
Zhu Z, Chen H, Yu W, Fu X, Xiang J, Li H, Zhang Y, Sun M, Wei Q, Zhao W, Zhao K. Number of Negative Lymph Nodes is Associated with Survival in Thoracic Esophageal Squamous Cell Carcinoma Patients Undergoing Three-Field Lymphadenectomy. Ann Surg Oncol. 2014.
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