Lymph nodes regression grade is a predictive marker for rectal cancer after neoadjuvant therapy and radical surgery

// Jun Li 1 , Jiatian Yuan 1 , Hao Liu 2 , Jie Yin 3 , Sai Liu 4 , Feng Du 5 , Junjie Hu 6 , Ci Li 7 , Xiangke Niu 8 , Bo Lv 1 , Shasha Xing 9 1 General Surgery Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, P.R. China 2 General Surgery Department, Second Affiliated Hospital of Jilin University, Changchun, P.R. China 3 General Surgery Department, Xuzhou Central Hospital, Xuzhou, P.R. China 4 Surgical Department of Gastrointestinal Diseases, Beijing Youan Hospital of Capital Medical University, Beijing, P.R. China 5 Internal Medicine-Oncology, Cancer Institute/Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P.R. China 6 Gastrointestinal Tumor Surgery, Hubei Cancer Hospital, Wuhan, P.R. China 7 Department of Pathology, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, P.R. China 8 Department of Radiology, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, P.R. China 9 Central Lab, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, P.R. China Correspondence to: Jun Li, e-mail: junl_paper@sina.com Jiatian Yuan, e-mail: jiatianyuan_pro@sina.com Shasha Xing, e-mail: xingshasha1230@126.com Keywords: lymph node, regression grading, rectal cancer, neoadjuvant therapy Received: October 10, 2015 Accepted: February 08, 2016 Published: February 25, 2016 ABSTRACT Neoadjuvant therapy (NT) for rectal cancer (RC) reduces primary tumors and involved lymph nodes. While a prognostic value of tumor regression grade (TRG) has been identified, involved lymph node regression grade (LRG) has not been systematically evaluated. Here, we evaluated the association of LRG with oncologic outcomes of RC patients after NT followed by radical surgery. 347 patients with locally advanced RC who received NT and then underwent radical surgery were retrospectively recruited between 2004 and 2011. Response to NT was evaluated by a 3-tier LRG and TRG based on the ratio of residual tumor to fibrosis. LRG was assessed in all patients (LRG 0, 170 patients [49.0%]; LRG 1, 100 patients [28.8%]; and LRG 2, 77 patients [22.2%]). LRG correlated with 5-year distant metastasis and 5-year disease free survival ( p =0.029 and 0.023, respectively). LRG also correlated with TRG ( p =0.017). We conclude that the LRG system may be an independent predictive factor of long-term oncologic outcomes of rectal cancer patients after NT and radical surgery.