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Nodal staging in rectal cancer: why is restaging after chemoradiation more accurate than primary nodal staging?

Abstract：

PURPOSE:This study aims to explore the influence of chemoradiation treatment (CRT) on rectal cancer nodes and to generate hypotheses why nodal restaging post-CRT is more accurate than at primary staging. METHODS:Thirty-nine patients with locally advanced rectal cancer underwent MRI pre- and post-CRT. All visible mesorectal nodes were measured on a 3D T1-weighted gradient echo (3D T1W GRE) sequence with 1-mm(3) voxels and matched between pre- and post-CRT-MRI and with histology by lesion-by-lesion matching. Change in number and size of nodes was compared between pre- and post-CRT-MRI. ROC curves were constructed to assess diagnostic performance of size. RESULTS:Eight hundred ninety-five nodes were found pre-CRT: 44 % disappeared and 40 % became smaller post-CRT. Disappearing nodes were initially significantly smaller than nodes that remained visible post-CRT: 2.9 mm vs. 3.8 mm. cN+ stage was predicted in 97 % pre-CRT and 36 % of patients had ypN+ post-CRT. ypN+ patients had significantly larger nodes than ypN0 patients both pre- and post-CRT. Optimal size cutoff for post-CRT ypN stage prediction was 2.5 mm (area under the curve (AUC) of 0.78) at MRI. CONCLUSIONS:After CRT, most lymph nodes become smaller, and many disappear. Size predicts disappearance and node positivity. Together with a low prevalence of ypN+, this can explain the higher accuracy of nodal staging after CRT than in a primary staging setting, possibly of use when considering organ-preserving strategies after CRT.

journal_name

Int J Colorectal Dis

journal_title

International journal of colorectal disease

authors

Heijnen LA,Maas M,Beets-Tan RG,Berkhof M,Lambregts DM,Nelemans PJ,Riedl R,Beets GL

doi

10.1007/s00384-016-2576-8

subject

Has Abstract

pub_date

2016-06-01 00:00:00

pages

1157-62

issue

6

eissn

0179-1958

issn

1432-1262

pii

10.1007/s00384-016-2576-8

journal_volume

31

pub_type

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