title: Lymph node status as a prognostic indicator after preoperative neoadjuvant chemoradiotherapy of rectal cancer.
abstract: OBJECTIVE
  The primary aim of this study was to examine lymph node status after neoadjuvant chemoradiotherapy (CRT) using a novel scoring system describing the pathological lymph node regression grade. The proposed scoring system was based on the percentage of fibrosis and the presence of residual tumour amount. The secondary aim of the study was to assess the oncological impact of this scoring system.
  
  
  METHODS
  The project was a retrospective cohort study over a 10-year period. Two hundred and two patients with rectal cancer who had received CRT followed by curative surgery were included. A histopathologist prospectively scored each specimen and the impact of the scoring system on survival and recurrence was analysed.
  
  
  RESULTS
  One hundred and ninety patients completed long-course preoperative CRT and formed the basis of the study. Overall, 40 recurrences (local and distant) were observed over a median follow-up of 36 months. The lymph node regression score was a significant predictor of tumour recurrence (hazard ratio 1.273, 95% CI 1.048-1.548; P = 0.015). The overall mortality rate was 21%, and a lower lymph node regression score was correlated with an improved survival curve (P = 0.01).
  
  
  CONCLUSIONS
  The results demonstrate that lymph node response to neoadjuvant CRT based on a nodal regression scoring system is related to recurrence.
authors.affiliation: Department of Academic Surgery, Dandenong Hospital, Melbourne, Victoria, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Mirbagheri
authors.forename: B
authors.initials: B
authors.lastname: Kumar
authors.forename: S
authors.initials: S
authors.lastname: Deb
authors.forename: B R
authors.initials: BR
authors.lastname: Poh
authors.forename: J G
authors.initials: JG
authors.lastname: Dark
authors.forename: C C
authors.initials: CC
authors.lastname: Leow
authors.forename: W M K
authors.initials: WM
authors.lastname: Teoh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D005355:Fibrosis; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Rectal neoplasms; chemoradiotherapy; lymph nodes; neoadjuvant therapy