Value of Size and Malignant Features of Lateral Lymph Nodes in Risk Stratification at Lateral Local Recurrence of Rectal Cancer: A National Cohort Study

Eline G M van Geffen; Tania C Sluckin; Sanne-Marije J A Hazen; Karin Horsthuis; Regina G H Beets-Tan; Susan van Dieren; Corrie A M Marijnen; Pieter J Tanis; Miranda Kusters; Dutch Snapshot Research Group

doi:10.6004/jnccn.2023.7081

Value of Size and Malignant Features of Lateral Lymph Nodes in Risk Stratification at Lateral Local Recurrence of Rectal Cancer: A National Cohort Study

J Natl Compr Canc Netw. 2024 Feb;22(1):17-25. doi: 10.6004/jnccn.2023.7081.

Authors

Eline G M van Geffen^{1

2}, Tania C Sluckin^{1

2}, Sanne-Marije J A Hazen^{1

2}, Karin Horsthuis^{2

3}, Regina G H Beets-Tan^{4

5

6

7}, Susan van Dieren¹, Corrie A M Marijnen^{8

9}, Pieter J Tanis^{2

10

11}, Miranda Kusters^{1

2}; Dutch Snapshot Research Group

Collaborators

Dutch Snapshot Research Group:
Arend G.J. Aalbers, Susanna M. van Aalten, Femke J. Amelung, Marjolein Ankersmit, Imogeen E. Antonisse, Jesse F. Ashruf, Tjeerd S. Aukema, Henk Avenarius, Renu R. Bahadoer, Frans C.H. Bakers, Ilsalien S. Bakker, Fleur Bangert, Renée M. Barendse, Heleen M.D. Beekhuis, Geerard L. Beets, Willem A. Bemelman, Maaike Berbée, Shira H. de Bie, Robert H.C. Bisschops, Robin D. Blok, Liselotte W. van Bockel, Anniek H. Boer, Frank C. den Boer, Evert-Jan G. Boerma, Leonora S.F. Boogerd, Jaap Borstlap, Wernard A.A. Borstlap, Johanna E. Bouwman, Sicco J. Braak, Manon N.G.J.A. Braat, Jennifer Bradshaw, Amarins T.A. Brandsma, Vivian van Breest Smallenburg, Wim T. van den Broek, Sjirk W. van der Burg, Jacobus W.A. Burger, Thijs A. Burghgraef, David W.G. ten Cate, Heleen M. Ceha, Jeltsje S. Cnossen, Robert R.J. Coebergh van den Braak, Esther C.J. Consten, Maaike Corver, Rogier M.P.H. Crolla, Sam Curutchet, Alette W. Daniëls-Gooszen, Paul H.P. Davids, Emmelie N. Dekker, Jan Willem T. Dekker, Ahmet Demirkiran, Tyche Derksen, Arjen L. Diederik, Anne M. Dinaux, Kemal Dogan, Ilse M. van Dop, Kitty E. Droogh-de Greve, Hanneke M.H. Duijsens, Michalda S. Dunker, Johan Duyck, Eino B. van Duyn, Laurentine S.E. van Egdom, Bram Eijlers, Youssef El-Massoudi, Saskia van Elderen, Anouk M.L.H. Emmen, Marc Engelbrecht, Anne C. van Erp, Jeroen A. van Essen, Hans F.J. Fabry, Thomas Fassaert, Eline A. Feitsma, Shirin S. Feshtali, Bas Frietman, Edgar J.B. Furnée, Anne M. van Geel, Elisabeth D. Geijsen, Anna A.W. van Geloven, Michael F. Gerhards, Hugo Gielkens, Renza A.H. van Gils, Lucas Goense, Marc J.P.M. Govaert, Wilhelmina M.U. van Grevenstein, E. Joline de Groof, Irene de Groot, Robbert J. de Haas, Nadia A.G. Hakkenbrak, Mariska D. den Hartogh, Vera Heesink, Joost T. Heikens, Ellen M. Hendriksen, Sjoerd van den Hoek, Erik J.R.J. van der Hoeven, Christiaan Hoff, Anna Hogewoning, Cornelis R.C. Hogewoning, Stefan Hoogendoorn, Francois van Hoorn, René L. van der Hul, Rieke van Hulst, Farshad Imani, Bas Inberg, Martijn P.W. Intven, Pedro Janssen, Chris E.J. de Jong, Jacoline Jonkers, Daniela Jou-Valencia, Bas Keizers, Stijn H.J. Ketelaers, Eva Knöps, Sebastiaan van Koeverden, Sylvia Kok, Stephanie E.M. Kolderman, Fleur I. de Korte, Robert T.J. Kortekaas, Julie C. Korving, Ingrid M. Koster, Jasenko Krdzalic, Pepijn Krielen, Leonard F. Kroese, Eveline J.T. Krul, Derk H.H. Lahuis, Bas Lamme, An A.G. van Landeghem, Jeroen W.A. Leijtens, Mathilde M. Leseman-Hoogenboom, Manou S. de Lijster, Martijn S. Marsman, Milou H. Martens, Ilse Masselink, Wout van der Meij, Philip Meijnen, Jarno Melenhorst, Dietrich J.L. de Mey, Julia Moelker-Galuzina, Linda Morsink, Erik J. Mulder, Karin Muller, Gijsbert D. Musters, Joost Nederend, Peter A. Neijenhuis, Lindsey C.F. de Nes, M Nielen, Jan B.J. van den Nieuwboer, Jonanne F. Nieuwenhuis, Joost Nonner, Bo J. Noordman, Stefi Nordkamp, Pim B. Olthof, Steven J. Oosterling, Daan Ootes, Vera Oppedijk, Pieter Ott, Ida Paulusma, Koen C.M.J. Peeters, Ilona T.A. Pereboom, Jan Peringa, Zoë Pironet, Joost D.J. Plate, Fatih Polat, Ingrid G.M. Poodt, Lisanne A.E. Posma, Jeroen F. Prette, Bareld B. Pultrum, Seyed M. Qaderi, Jan M. van Rees, Rutger-Jan Renger, Anouk J.M. Rombouts, Lodewijk J. Roosen, Ellen A. Roskott-ten Brinke, Joost Rothbarth, Dennis B. Rouw, Tom Rozema, Heidi Rütten, Harm J.T. Rutten, Marit E. van der Sande, Boudewijn E. Schaafsma, Renske A. Schasfoort, Merel M. Scheurkogel, Arjan P. Schouten van der Velden, Wilhelmina H. Schreurs, Puck M.E. Schuivens, Colin Sietses, Petra C.G. Simons, Marjan J. Slob, Gerrit D. Slooter, Martsje van der Sluis, Bo P. Smalbroek, Anke B. Smits, Ernst J. Spillenaar-Bilgen, Patty H. Spruit, Tanja C. Stam, Jaap Stoker, Aaldert K. Talsma, Sofieke J.D. Temmink, G.Y. Mireille The, Jeroen A.W. Tielbeek, Aukje A.J.M. van Tilborg, Fiek van Tilborg, Dorothée van Trier, Jurriaan B. Tuynman, Maxime J. M. van der Valk, Inge J.S. Vanhooymissen, G. Boudewijn C. Vasbinder, Cornelis J. Veeken, Laura A. Velema, Anthony W.H. van de Ven, Emiel G.G. Verdaasdonk, Wouter M. Verduin, Tim Verhagen, Paul M. Verheijen, Maarten Vermaas, An-Sofie E. Verrijssen, Anna V.D. Verschuur, Harmke Verwoerd-van Schaik, Roy F.A. Vliegen, Sophie Voets, F. Jeroen Vogelaar, Clementine L.A. Vogelij, Johanna Vos-Westerman, Marianne de Vries, Joy C. Vroemen, Bas S.T. van Vugt, Johannes A. Wegdam, Bob J. van Wely, Marinke Westerterp, Paul P. van Westerveld, Henderik L. van Westreenen, Allard G. Wijma, Johannes H.W. de Wilt, Bart W.K. de Wit, Fennie Wit, Karlijn Woensdregt, Victor van Woerden, Floor S.W. van der Wolf, Sander van der Wolk, Johannes M. Wybenga, Edwin S. van der Zaag, Bobby Zamaray, Herman J.A. Zandvoort, Dennis van der Zee, Annette Zeilstra, Kang J. Zheng, David D.E. Zimmerman, Marcel Zorgdrager

Affiliations

¹ Department of Surgery, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
² Cancer Center Amsterdam, Treatment and Quality of Life, Imaging and Biomarkers, Amsterdam, the Netherlands.
³ Department of Radiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
⁴ Department of Radiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
⁵ GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands.
⁶ Department of Radiology, Odense University Hospital, Odense, Denmark.
⁷ Department of Clinical Research University of Southern Denmark, Odense, Denmark.
⁸ Department of Radiation Oncology, Leiden UMC, Leiden, the Netherlands.
⁹ Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
¹⁰ Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
¹¹ Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.

PMID: 38394768
DOI: 10.6004/jnccn.2023.7081

Abstract

Background: Patients with rectal cancer who have enlarged lateral lymph nodes (LLNs) have an increased risk of lateral local recurrence (LLR). However, little is known about prognostic implications of malignant features (internal heterogeneity, irregular margins, loss of fatty hilum, and round shape) on MRI and number of enlarged LLNs, in addition to LLN size.

Methods: Of the 3,057 patients with rectal cancer included in this national, retrospective, cross-sectional cohort study, 284 with a cT3-4 tumor located ≤8 cm from the anorectal junction who received neoadjuvant treatment and who had visible LLNs on MRI were selected. Imaging was reassessed by trained radiologists. LLNs were categorized based on size. Influence of malignant features and the number of LLNs on LLR was investigated.

Results: Of 284 patients with at least 1 visible LLN, 122 (43%) had an enlarged node (≥7.0 mm) and 157 (55%) had malignant features. Of the 122 patients with enlarged nodes, 25 had multiple (≥2). In patients with a single enlarged node (n=97), a single malignant feature was associated with a 4-year LLR rate of 0% and multiple malignant features was associated with a rate of 17% (P=.060). In the group with multiple malignant features, their disappearance on restaging was associated with an LLR rate of 13% compared with an LLR rate of 20% for persistent malignant features (P=.532). The presence of intermediate-size LLNs (5.0-6.9 mm) with at least 1 malignant feature was associated with a 4-year LLR rate of 8%; the 4-year LLR rate was 13% when the malignant features persisted on restaging MRI (P=.409). Patients with multiple enlarged LLNs had a 4-year LLR rate of 28% compared with 11% for those with a single enlarged LLN (P=.059).

Conclusions: The presence of multiple enlarged LLNs (≥7.0 mm), as well as multiple malignant features in an enlarged node contribute to the risk of developing an LLR. These radiologic features can be used for clinical decision-making regarding the potential benefit of LLN dissection.

Keywords: lateral local recurrence; lateral lymph nodes; malignant features; rectal cancer; risk-stratification.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cohort Studies
Cross-Sectional Studies
Humans
Lymph Node Excision / methods
Lymph Nodes* / pathology
Neoplasm Recurrence, Local / epidemiology
Neoplasm Recurrence, Local / pathology
Neoplasm Staging
Rectal Neoplasms* / diagnostic imaging
Rectal Neoplasms* / epidemiology
Rectal Neoplasms* / therapy
Retrospective Studies
Risk Assessment