European journal of cancer (Oxford, England : 1990) · 2025
Implications of inaccurate lymph node staging in early and intermediate-risk rectal cancer on survival-related outcomes in a large Dutch population-based cohort.
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Vande Kerckhove F E C, van den Berg K, van Erning F N, Daniels-Gooszen A W, Verrijssen A E, Peulen H M U, Rutten H J T, van Hellemond I E G, Bloemen J G, Burger J W A, Nederend J, Tolenaar J L, Ketelaers S H J
Аннотация
INTRODUCTION: While clinical lymph node status remains a key determinant in rectal cancer treatment, its accuracy is limited. This study aimed to evaluate the impact of inaccurate MRI-based nodal staging on survival in early and intermediate-risk rectal cancer in a Dutch national cohort.
METHODS: This retrospective study analysed data from the Netherlands Cancer Registry. Rectal cancer patients diagnosed between 2014 and 2017 with cT1-3N0M0 rectal cancer undergoing direct TME surgery, and cT1-3N1M0 rectal cancer receiving neoadjuvant short-course radiotherapy (SCRT) followed by direct TME surgery were included. Patients were categorized in four groups based on clinical (cN) and pathological (pN) nodal status: cN0pN0, cN0pN1, cN1pN0, and cN1pN1. Overall survival (OS) and factors associated with OS were analysed using Kaplan-Meier and Cox regression analyses.
RESULTS: Among 4080 patients, 19.5 % of 3075 cN0 patients were understaged (pN1) and 62.4 % of 1005 cN1 patients were overstaged (pN0). After a median follow up of 5.7 (IQR 4.6-6.6) years, OS did not differ between cN0pN1 patients undergoing direct surgery and cN1pN1 patients receiving neoadjuvant SCRT followed by surgery (p = 0.154). Multivariable Cox regression analysis revealed that inaccurate cN0 staging was not independently associated with worse OS in pN1 patients, while pT3 disease (HR 1.62, 95 %-CI 1.15-2.27 for pN1; and HR 1.52, 95 %-CI 1.22-1.88 for pN0) was associated with worse OS compared to pT1-2 in both pN1 and pN0 patients.
CONCLUSION: Inaccurate clinical nodal staging by MRI is common in early and intermediate-risk rectal cancer, but it does not seem to have a negative impact on OS.
METHODS: This retrospective study analysed data from the Netherlands Cancer Registry. Rectal cancer patients diagnosed between 2014 and 2017 with cT1-3N0M0 rectal cancer undergoing direct TME surgery, and cT1-3N1M0 rectal cancer receiving neoadjuvant short-course radiotherapy (SCRT) followed by direct TME surgery were included. Patients were categorized in four groups based on clinical (cN) and pathological (pN) nodal status: cN0pN0, cN0pN1, cN1pN0, and cN1pN1. Overall survival (OS) and factors associated with OS were analysed using Kaplan-Meier and Cox regression analyses.
RESULTS: Among 4080 patients, 19.5 % of 3075 cN0 patients were understaged (pN1) and 62.4 % of 1005 cN1 patients were overstaged (pN0). After a median follow up of 5.7 (IQR 4.6-6.6) years, OS did not differ between cN0pN1 patients undergoing direct surgery and cN1pN1 patients receiving neoadjuvant SCRT followed by surgery (p = 0.154). Multivariable Cox regression analysis revealed that inaccurate cN0 staging was not independently associated with worse OS in pN1 patients, while pT3 disease (HR 1.62, 95 %-CI 1.15-2.27 for pN1; and HR 1.52, 95 %-CI 1.22-1.88 for pN0) was associated with worse OS compared to pT1-2 in both pN1 and pN0 patients.
CONCLUSION: Inaccurate clinical nodal staging by MRI is common in early and intermediate-risk rectal cancer, but it does not seem to have a negative impact on OS.