Prevalence of nodal involvement in rectal cancer after chemoradiotherapy

H. E. Haak, G. L. Beets, K. Peeters, P. J. Nelemans, V. Valentini, C. Rödel, L. Kuo, F. A. Calvo, J. Garcia-Aguilar, R. Glynne-Jones, S. Pucciarelli, J. Suarez, G. Theodoropoulos, S. Biondo, D. M.J. Lambregts, R. G.H. Beets-Tan

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)


Background: The purpose of this study was to investigate the prevalence of ypN+ status according to ypT category in patients with locally advanced rectal cancer treated with chemoradiotherapy and total mesorectal excision, and to assess the impact of ypN+ on disease recurrence and survival by pooled analysis of individual-patient data. Methods: Individual-patient data from 10 studies of chemoradiotherapy for rectal cancer were included. Pooled rates of ypN+ disease were calculated with 95 per cent confidence interval for each ypT category. Kaplan-Meier and Cox regression analyses were undertaken to assess influence of ypN status on 5-year disease-free survival (DFS) and overall survival (OS). Results: Data on 1898 patients were included in the study. Median follow-up was 50 (range 0-219) months. The pooled rate of ypN+ disease was 7 per cent for ypT0, 12 per cent for ypT1, 17 per cent for ypT2, 40 per cent for ypT3, and 46 per cent for ypT4 tumours. Patients with ypN+ disease had lower 5-year DFS and OS (46.2 and 63.4 per cent respectively) than patients with ypN0 tumours (74.5 and 83.2 per cent) (P < 0.001). Cox regression analyses showed ypN+ status to be an independent predictor of recurrence and death. Conclusion: Risk of nodal metastases (ypN+) after chemoradiotherapy increases with advancing ypT category and needs to be considered if an organ-preserving strategy is contemplated.

Original languageEnglish
Pages (from-to)1251-1258
Number of pages8
JournalBritish Journal of Surgery
Issue number10
Publication statusPublished - Oct 1 2021

ASJC Scopus subject areas

  • Surgery


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