title: The impact of pathologic nodal status on survival following neoadjuvant chemoradiation for locally advanced rectal cancer.
abstract: OBJECTIVE
  For patients with locally advanced rectal cancer, the accuracy rates of preneoadjuvant therapy nodal staging and potential nodal downstaging make the prognostic significance of nodal status unclear. We therefore sought to review our experience in order to better understand the impact of clinical and pathologic nodal status upon patient outcomes.
  
  
  METHODS
  174 patients were identified as having undergone neoadjuvant chemoradiation and resection for rectal cancer. For analytic purposes, patients were grouped into four nodal categories (uN( 0)· pN( 0), uN( 0)· pN( +), uN (+) · pN( 0), and uN (+) · pN( +)). Univariate and multivariate analyses were performed.
  
  
  RESULTS
  104 men and 70 women of median age 60 years (29-85 years) were followed for a median of 31 months (1-121 months). Nodal staging was available for 129 patients, with a median of 8 lymph nodes (range 0-39) evaluated. Disease recurred in 3 of 41 (7%) uN   (0) ·pN (  0), 10 of 52 (20%) uN (   +)·pN (  0), 7 of 18 (41%) uN (  0)·pN (   +), and 6 of 17 (35%) uN (  +)·pN (  +) patients. Those patients having nodal downstaging (uN (  +)·pN (  0)) experienced superior overall survival (p = 0.03). Only pathologic nodal status was a significant predictor of both disease-free and overall survival in multivariate modeling. Adjuvant chemotherapy did not impact disease-free or overall survival for patients with pN0.
  
  
  CONCLUSIONS
  Pathologic nodal status may represent a superior predictor of survival for patients with local advanced rectal cancers. Our findings may have potential implications for the application of adjuvant therapy.
authors: Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
authors: Jonathan M
authors: JM
authors: Hernandez
authors: Whalen
authors: W
authors: Clark
authors: Jill
authors: J
authors: Weber
authors: William J
authors: WJ
authors: Fulp
authors: Lauren
authors: L
authors: Lange
authors: David
authors: D
authors: Shibata
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome