AUTHOR=Chen Bin , Liu Xing , Zhang Yiyi , Zhuang Jinfu , Peng Yong , Wang Ye , Wu Yong , Li Shoufeng , Yang Yuanfeng , Guan Guoxian 

TITLE=Prognostic Value of the Distribution of Lymph Node Metastasis in Locally Advanced Rectal Cancer After Neoadjuvant Chemoradiotherapy

JOURNAL=Frontiers in Surgery

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2021.749575

DOI=10.3389/fsurg.2021.749575

ISSN=2296-875X

ABSTRACT=<p><bold>Background:</bold> The objective of this study is to assess the prognostic value of lymph node metastasis distribution (LND) in locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy (nCRT).</p><p><bold>Methods:</bold> This study included 179 patients with pathological stage III LARC who underwent nCRT followed by radical surgery. LND was classified into three groups: LND1, lymph node metastasis at the mesorectum (140/179, 78.2%); LND2, lymph node metastasis along the inferior mesenteric artery trunk nodes (26/179, 14.5%); LND3, lymph node metastasis at the origin of the IMA (13/179, 7.3%). Clinicopathologic characteristics were analyzed to identify independent prognostic factors.</p><p><bold>Result:</bold> LND showed better stratification for 3-year DFS (LND1 66.8, LND2 50, and LND3 15.4%, <italic>P</italic> &lt; 0.01) compared to the ypN (3-year DFS: N1 59.9 and N2 60.3%, <italic>P</italic> = 0.34) and ypTNM (3-year DFS: IIIA 68.6%, IIIB 57.5%, and IIIC 53.5, <italic>P</italic> = 0.19) staging systems. Similar results were found for 3-year LRFS and DMFS. According to multivariate survival analysis, LND was shown to be an independent prognostic factor for DFS, LRFS, and DMFS in patients with positive lymph nodes (<italic>P</italic> &lt; 0.01, in all cases).</p><p><bold>Conclusion:</bold> LND is an independent prognostic factor in stage III rectal cancer after nCRT. LND can be used as a supplementary indicator for the ypTNM staging system in patients with LARC after nCRT.</p>