[Risk factors related to lymph node metastases after neoadjuvant therapy for locally advanced rectal cancer].
OBJECTIVE
Neoadjuvant therapy (radiotherapy, RT or chemoradiotherapy, CRT) could change status of the invasion and lymph node metastasis of rectal cancer. The risk factors of lymph node metastasis in rectal cancers without neoadjuvant therapy have been well known, but those in rectal cancers treated with preoperative RT or CRT remain unclear. This study was to investigate the risk factors of lymph node metastasis in patients who underwent preoperative RT or CRT for rectal cancers.


METHODS
Clinical data of 93 patients underwent preoperative RT or CRT followed by total mesorectal exesion (TME) for locally advanced rectal adenocarcinoma from August, 2003 to February, 2008 were reviewed. Twelve clinicopathologic factors and treatment-related factors were studied with univariate and multivariate analyses.


RESULTS
Univariate analysis showed that post-RT or post-CRT serum carcinoembryonic antigen (CEA) level, radiation dose, time interval from RT or CRT to TME, concurrent chemotherapy with oxaliplatin-containing regimens, and infiltration extent to bowel wall after RT or CRT (ypT stage) were significantly associated with lymph node status after RT or CRT (ypN stage). Multivariate analysis showed that concurrent chemotherapy with oxaliplatin-containing regimens (r=-0.481, P<0.01) and ypT stage (r=0.503, P<0.01) were independent risk factors of ypN stage.


CONCLUSIONS
Pathologic T stage is the most reliable predictor of lymph node stage in rectal cancer patients received preoperative RT or CRT. Oxaliplatin-containing regimens could significantly reduce the risks of lymph node metastases and potentially improve the prognosis.
Zeng
Zhi-Fan
ZF
State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, 510060, PR China.
Ding
Pei-Rong
PR
Pan
Zhi-Zhong
ZZ
Lin
Jun-Zhong
JZ
Li
Li-Ren
LR
Lu
Zhen-Hai
ZH
Wu
Xiao-Jun
XJ
Kong
Ling-Heng
LH
Zhou
Zhong-Guo
ZG
Wan
De-Sen
DS
D000230:Adenocarcinoma / Q000097:blood / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018395:CA-19-9 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D002955:Leucovorin / Q000627:therapeutic use; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D000077150:Oxaliplatin; D011300:Preoperative Care; D011829:Radiation Dosage; D012004:Rectal Neoplasms / Q000097:blood / Q000473:pathology / Q000628:therapy*; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D002955:Leucovorin; D005472:Fluorouracil