Can clinicopathological parameters predict for lymph node metastases in ypT0-2 rectal carcinoma? Results of the CAO/ARO/AIO-94 and CAO/ARO/AIO-04 phase 3 trials
Von Den Gruen JM, Hartmann A, Fietkau R, Ghadimi M, Liersch T, Hohenberger W, Weitz J, Sauer R, Wittekind C, Stroebel P, Roedel C, Fokas E (2018)
Publication Type: Journal article
Publication year: 2018
Journal
Book Volume: 128
Pages Range: 557-563
Journal Issue: 3
DOI: 10.1016/j.radonc.2018.06.008
Abstract
BACKGROUND: The advent of less radical surgical approaches has generated concern about leaving locoregional lymph node metastases (LNM) unresected that could lead to adverse outcome. We examined the prognostic role of clinicopathological factors for ypN-positivity in patients with ypT0-2 rectal carcinoma treated within the CAO/ARO/AIO-94 and CAO/ARO/AIO-04 randomized phase 3 trials. METHODS: The correlation of clinicopathological factors with ypN-status (ypN0 vs ypN1/2) was examined in n = 776 patients with ypT0-2 rectal carcinoma after preoperative CRT and total mesorectal excision surgery using Pearson's Chi-squared test for categorical variables and Kruskal-Wallis' test for continuous variables. Multivariable analysis was performed using binary logistic regression to identify independent prognosticators for ypN-positivity. RESULTS: Residual LNM (ypN+) were found in 6%, 20.8% and 21.4% of patients with ypT0, ypT1 and ypT2 carcinomas, respectively. Independent prognosticators for LNM were advanced ypT category (p = 0.002) and lymphatic invasion (p = 0.020). In a separate multivariable analysis performed upon exclusion of ypT-category due to multicollinearity with residual tumor diameter (RTD), lymphatic invasion (p = 0.015) and RTD ≥10 mm (p = 0.005) demonstrated strong correlation with LNM. CONCLUSION: Advanced ypT-stage, lymphatic invasion and RTD ≥10 mm were prognostic factors for LNM in patients ypT0-2 rectal carcinoma treated with CRT and surgery within both phase 3 trials. The high incidence of LNM in the ypT1-2 group needs to be taken into consideration in the context of oncological safety and indicate that LE should be advocated with great caution in this patient subgroup. The prognostic pathological factor identified here could help guide decision of LE vs TME after standard CRT.
Authors with CRIS profile
Arndt Hartmann
Lehrstuhl für Allgemeine Pathologie und Pathologische Anatomie
Rainer Fietkau
Lehrstuhl für Strahlentherapie
Werner Hohenberger
Lehrstuhl für Allgemein- und Viszeralchirurgie
Involved external institutions
Goethe-Universität Frankfurt am Main
Germany (DE)
Universitätsklinikum Heidelberg
Germany (DE)
Technische Universität Dresden
Germany (DE)
Universitätsklinikum Leipzig
Germany (DE)
Universitätsklinikum Göttingen
Germany (DE)
Germany (DE)
Universitätsklinikum Heidelberg
Germany (DE)
Technische Universität Dresden
Germany (DE)
Universitätsklinikum Leipzig
Germany (DE)
Universitätsklinikum Göttingen
Germany (DE)
How to cite
APA:
Von Den Gruen, J.M., Hartmann, A., Fietkau, R., Ghadimi, M., Liersch, T., Hohenberger, W.,... Fokas, E. (2018). Can clinicopathological parameters predict for lymph node metastases in ypT0-2 rectal carcinoma? Results of the CAO/ARO/AIO-94 and CAO/ARO/AIO-04 phase 3 trials. Radiotherapy and Oncology, 128(3), 557-563. https://dx.doi.org/10.1016/j.radonc.2018.06.008
MLA:
Von Den Gruen, Jens Mueller, et al. "Can clinicopathological parameters predict for lymph node metastases in ypT0-2 rectal carcinoma? Results of the CAO/ARO/AIO-94 and CAO/ARO/AIO-04 phase 3 trials." Radiotherapy and Oncology 128.3 (2018): 557-563.
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