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Yang H, Xing J, Zhang C, Yao Z, Wu X, Jiang B, Cui M, Su X. Lymph node yield less than 12 is not a poor predictor of survival in locally advanced rectal cancer after laparoscopic TME following neoadjuvant chemoradiotherapy. Front Oncol 2022; 12:1080475. [PMID: 36568169 PMCID: PMC9773987 DOI: 10.3389/fonc.2022.1080475] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
Purpose Previous studies have confirmed that neoadjuvant chemoradiotherapy (nCRT) may reduce the number of lymph nodes retrieved in rectal cancer. However, it is still controversial whether it is necessary to harvest at least 12 lymph nodes for locally advanced rectal cancer (LARC) patients who underwent nCRT regardless of open or laparoscopic surgery. This study was designed to evaluate the relationship between lymph node yield (LNY) and survival in LARC patients who underwent laparoscopic TME following nCRT. Methods Patients with LARC who underwent nCRT followed by laparoscopic TME were retrospectively analyzed. The relationship between LNY and survival of patients was evaluated, and the related factors affecting LNY were explored. To further eliminate the influence of imbalance of clinicopathological features on prognosis between groups, propensity score matching was conducted. Results A total of 257 consecutive patients were included in our study. The median number of LNY was 10 (7 to 13) in the total cohort. There were 98 (38.1%) patients with 12 or more lymph nodes harvested (LNY ≥12 group), and 159 (61.9%) patients with fewer than 12 lymph nodes retrieved (LNY <12 group). There was nearly no significant difference between the two groups in clinicopathologic characteristics and surgical outcomes except that the age of LNY <12 group was older (P<0.001), and LNY <12 group tended to have more TRG 0 cases (P<0.060). However, after matching, when 87 pairs of patients obtained, the clinicopathological features were almost balanced between the two groups. After a median follow-up of 65 (54 to 75) months, the 5-year OS was 83.9% for the LNY ≥12 group and 83.6% for the LNY <12 group (P=0.893), the 5-year DFS was 78.8% and 73.4%, respectively (P=0.621). Multivariate analysis showed that only patient age, TRG score and ypN stage were independent factors affecting the number of LNY (all P<0.05). However, no association was found between LNY and laparoscopic surgery-related factors. Conclusions For LARC patients who underwent nCRT followed by laparoscopic TME, the number of LNY less than 12 has not been proved to be an adverse predictor for long-term survival. There was no correlation between LNY and laparoscopic surgery-related factors.
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Yoshida M, Cesmecioglu E, Firat C, Sakamoto H, Teplov A, Kawata N, Ntiamoah P, Ohnishi T, Ibrahim K, Vakiani E, Garcia-Aguilar J, Hameed M, Shia J, Yagi Y. Pathological Evaluation of Rectal Cancer Specimens Using Micro-Computed Tomography. Diagnostics (Basel) 2022; 12:diagnostics12040984. [PMID: 35454033 PMCID: PMC9044748 DOI: 10.3390/diagnostics12040984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/12/2022] [Indexed: 12/10/2022] Open
Abstract
Whole-block imaging (WBI) using micro-computed tomography (micro-CT) allows the nondestructive reconstruction of a three-dimensional view of tissues, implying that WBI may be used for accurate pathological evaluation of patients with rectal cancer. HOWEVER, the clinical impact of this approach is unclear. We aimed to clarify the efficacy of WBI in the whole-mount specimens of locally advanced rectal cancer. A total of 237 whole-mount formalin-fixed paraffin-embedded blocks from 13 patients with rectal cancer who underwent surgical treatment were enrolled and scanned with micro-CT to generate three-dimensional images. WBI was evaluated following the conventional pathological review of the corresponding whole-slide imaging (WSI). WBI identified all tumor sites detected using WSI. Furthermore, WBI revealed one additional tumor site, which was not detected using WSI. Tumor resection margin was significantly closer to the soft-tissue edge when measured using WBI (7.7 mm vs. 6.6 mm, p < 0.01). Seventy-six percent of tumor deposits on WSI were changed according to the evidence of tumor interaction with the surrounding tissues confirmed using WBI. Furthermore, WBI revealed 25 additional lymph nodes, six of which were metastatic. The combination of conventional hematoxylin and eosin-stained imaging and WBI may contribute to an accurate pathological assessment.
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Affiliation(s)
- Masao Yoshida
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (E.C.); (C.F.); (A.T.); (P.N.); (T.O.); (K.I.); (E.V.); (M.H.); (J.S.); (Y.Y.)
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 411-8777, Japan;
- Correspondence: ; Tel.: +1-646-888-7617; Fax: +1-929-321-7025
| | - Emine Cesmecioglu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (E.C.); (C.F.); (A.T.); (P.N.); (T.O.); (K.I.); (E.V.); (M.H.); (J.S.); (Y.Y.)
- Department of Pathology, Marmara University Research and Education Hospital, Istanbul 34899, Turkey
| | - Canan Firat
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (E.C.); (C.F.); (A.T.); (P.N.); (T.O.); (K.I.); (E.V.); (M.H.); (J.S.); (Y.Y.)
| | - Hirotsugu Sakamoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi 329-0498, Japan;
| | - Alexei Teplov
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (E.C.); (C.F.); (A.T.); (P.N.); (T.O.); (K.I.); (E.V.); (M.H.); (J.S.); (Y.Y.)
| | - Noboru Kawata
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 411-8777, Japan;
| | - Peter Ntiamoah
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (E.C.); (C.F.); (A.T.); (P.N.); (T.O.); (K.I.); (E.V.); (M.H.); (J.S.); (Y.Y.)
| | - Takashi Ohnishi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (E.C.); (C.F.); (A.T.); (P.N.); (T.O.); (K.I.); (E.V.); (M.H.); (J.S.); (Y.Y.)
| | - Kareem Ibrahim
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (E.C.); (C.F.); (A.T.); (P.N.); (T.O.); (K.I.); (E.V.); (M.H.); (J.S.); (Y.Y.)
| | - Efsevia Vakiani
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (E.C.); (C.F.); (A.T.); (P.N.); (T.O.); (K.I.); (E.V.); (M.H.); (J.S.); (Y.Y.)
| | - Julio Garcia-Aguilar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Meera Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (E.C.); (C.F.); (A.T.); (P.N.); (T.O.); (K.I.); (E.V.); (M.H.); (J.S.); (Y.Y.)
| | - Jinru Shia
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (E.C.); (C.F.); (A.T.); (P.N.); (T.O.); (K.I.); (E.V.); (M.H.); (J.S.); (Y.Y.)
| | - Yukako Yagi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (E.C.); (C.F.); (A.T.); (P.N.); (T.O.); (K.I.); (E.V.); (M.H.); (J.S.); (Y.Y.)
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