T stage-dependent lymph node and distant metastasis and the accuracy of lymph node assessment in rectal cancer

Abstract

To analyze data obtained in a representative number of patients with primary rectal cancer with respect to lymph node diagnostics and related tumor stages. In pT2-, pT3-, and pT4 rectal cancer lesions, the impact of investigated lymph nodes on the frequency of pN+ status, the cumulative risk of metachronous distant metastases, and overall survival was studied by means of a prospective multicenter observational study over a defined period of time. From 2000 to 2011, the proportion of surgical specimens with ≥\u202f12 investigated lymph nodes increased significantly, from 73.6% to 93.2% (p\u202f<\u20090.001; the number of investigated lymph nodes from 16.2 to 20.8; p\u202f<\u20090.001). Despite this, the percentage of pN+ rectal cancer lesions varied only non-significantly (39.9% to 45.9%; p\u202f=\u20090.130; median, 44.1%). For pT2-, pT3-, and pT4 rectal cancer lesions, there was an increasing proportion of pN+ findings correlating significantly with the number of investigated lymph nodes up to n\u202f=\u200912 investigated lymph nodes. Only in pT3 rectal cancer was there a significant increase in pN+ findings in case of >\u202f12 lymph nodes (p\u202f=\u20090.001), but not in pT2 (p\u202f=\u20090.655) and pT4 cancer lesions (p\u202f=\u20090.256). For pT3pN0cM0 rectal cancer, the risk of metachronous distant metastases and overall survival did not depend on the number of investigated lymph nodes. In rectal cancer, at least n\u202f=\u200912 lymph nodes are to be minimally investigated. The investigation of fewer lymph nodes is associated with a higher risk of false-negative pN0 findings. In particular, in pT3 rectal cancer, the investigation of more than 12 lymph nodes lowers the risk of false-negative pN0 findings. An upstaging effect by the investigation of a possibly maximal number of lymph nodes could not be detected.