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

Authors Dai W, Li Y, Wu Z, Feng Y, Cai S, Xu Y, Li Q, Cai G

Received 26 March 2018

Accepted for publication 9 July 2018

Published 7 January 2019 Volume 2019:11 Pages 537—546


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Professor Nakshatri

Weixing Dai,1,2,* Yaqi Li,1,2,* Zhenyu Wu,3,* Yang Feng,1,2 Sanjun Cai,1,2 Ye Xu,1,2 Qingguo Li,1,2 Guoxiang Cai1,2

1Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China; 2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China; 3Department of Biostatistics, School of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China

*These authors contributed equally to this work

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 neoadjuvant 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

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