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Emile SH, Maron DJ, Horesh N, Garoufalia Z, Gefen R, Zhou P, Wexner SD. Predictors of Nodal Disease in Rectal Cancer Patients with Complete Mucosal Response to Neoadjuvant Therapy. World J Surg 2023; 47:2013-2022. [PMID: 37084107 DOI: 10.1007/s00268-023-07012-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Some patients with locally advanced rectal cancer (LARC) achieve complete mucosal response following neoadjuvant therapy (NAT) and may be candidates for watch and wait strategy. This study aimed to identify predictors of nodal disease in patients with LARC who had a complete mucosal response to NAT. METHODS This case-control study included patients with LARC who were treated with NAT in the National Cancer Database between 2004 and 2019. Patients with complete mucosal response, defined as pathologic T0, were identified and classified according to the status of the pathologic N stage into complete response (pT0, pN0) and complete mucosal response with positive nodal disease (pT0, pN +). The two groups were compared regarding baseline demographics and tumor characteristics to determine the predictors of nodal disease after NAT. RESULTS A total of 5529 patients (59.7% male) with a mean age of 59.6 ± 12.2 years had a complete mucosal response following NAT. Nodal disease was detected in 443 (8%) patients with a complete mucosal response. Independent predictors of nodal disease were clinical N + stage (OR: 1.87, p < 0.001), mucinous histology (OR: 3.8, p = 0.003), and lymphovascular invasion (OR = 4.01, p < 0.001). The clinical T stage was inversely related to the risk of nodal disease. CONCLUSIONS Despite having a complete mucosal response following NAT, 8% of patients had nodal disease. Clinical evidence of nodal involvement on preoperative assessment, mucinous tumor histology, and lymphovascular invasion predicted nodal disease after NAT. These findings should be considered when making a decision on watch and wait strategy in patients with clinical complete response.
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Affiliation(s)
- Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
| | - David J Maron
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
| | - Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
- Department of Surgery and Transplantation, Sheba Medical Center, Ramat Gan, Tel Aviv University, Tel Aviv, Israel
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
| | - Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
- Department of General Surgery, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peige Zhou
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
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Prugmahachaikul A, Sanpavat A. Prognostic Significance of Lymphovascular Invasion Detected by D2-40 in Low-Risk Stage II Colon Cancer. Cureus 2021; 13:e19825. [PMID: 34963842 PMCID: PMC8702388 DOI: 10.7759/cureus.19825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 01/05/2023] Open
Abstract
Background Lymphovascular invasion (LVI) is included in the criteria of high-risk stage II colon cancer. However, there are limitations to detecting LVI by routine hematoxylin and eosin (H&E) staining. Alternatively, immunohistochemistry (IHC) for the lymphatic endothelial marker D2-40 may help detect LVI, but its prognostic significance remains unknown. This study aimed to evaluate the prognostic significance of LVI, detected by IHC for D2-40, in low-risk stage II colon cancer. Materials and Methods A total of 69 patients with low-risk stage II colon cancer were tested for D2-40 to assess LVI. Then, the relationships between IHC-detected LVI and clinical outcomes, including disease-free survival (DFS) and overall survival (OS), were analyzed using both univariate and multivariate analyses. Results IHC for D2-40 revealed that 24 out of the 69 cases (34.78%) had LVI-positive tumors. IHC-detected LVI was significantly associated with adverse clinical outcomes on univariate analysis, i.e., both reduced DFS (P = 0.002) and OS (P = 0.0163). In multivariate analysis, controlling for age, IHC-detected LVI remained a significant predictor of reduced DFS with a hazard ratio (HR) of 3.37 and a 95% confidence interval (CI) of 1.39-8.15 (P = 0.007) and OS (HR, 5.66; 95% CI, 1.02-31.51; P = 0.048). Conclusions Our results demonstrated that IHC analysis for D2-40 enhanced LVI detection in patients with low-risk stage II colon cancer and that cases with a missed diagnosis of LVI by routine H&E staining had adverse clinical outcomes, that is, reduced DFS and OS.
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