Pathological nodal staging score for rectal cancer patients treated with radical surgery with or without neoadjuvant therapy: a postoperative decision tool

Abstract

Background

Lymph node status can predict the prognosis of patients with rectal cancer treated with surgery. Thus, we sought to establish a standard for the minimum number of lymph nodes (LNs) examined in patients with rectal cancer by evaluating the probability that pathologically negative LNs prove positive during surgery.

Patients and methods

We extracted information of 31,853 patients with stage I–III rectal carcinoma registered between 2004 and 2013 from the Surveillance, Epidemiology, and End Results database and divided them into two groups: the first group was SURG, including patients receiving surgery directly and the other group was NEO, encompassing those underwent neo-adjuvant therapy. Using a beta-binomial model, we developed nodal staging score (NSS) based on pT/ypT stage and the number of LNs retrieved.

Results

In both cohorts, the false-negative rate was estimated to be 16% when 12 LNs were examined, but it dropped to 10% when 20 LNs were evaluated. In the SURG cohort, to rule out 90% possibility of false staging, 3, 7, 28, and 32 LNs would be necessarily examined in patients with pT1–4 disease, respectively. While in the NEO cohort, 4, 7, 12, and 16 LNs would be included for examination in patients with ypT1–4 disease to guarantee an NSS of 90%.

Conclusion

By determining whether a rectal cancer patient with negative LNs was appropriately staged, the NSS model we developed in this study may assist in tailoring postoperative management.

Keywords:

• nodal staging score
• rectal cancer
• lymph node
• neoadjuvant therapy
• beta-binomial model

Supplementary material

Figure S1 Cancer-specific survival analysis of pT4N0/ypT4N0 patients compared with patients at stage IIIA and pT3N0/ypT3N0 in both SURG (A) and NEO (B) cohorts.

Acknowledgments

We appreciate the SEER program for making the database publicly available. This work was supported by the National Natural Science Foundation of China (grant no. 81572351).

Author contributions

Conception and design: Weixing Dai. Financial support: Guoxiang Cai, Ye Xu. Collection and assembly of data: Qingguo Li. Statistical analysis: Zhenyu Wu, Yang Feng. Manuscript writing: Yaqi Li. Final approval of manuscript: Gouxiang Cai, Qingguo Li. All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.