• 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, Beets-TanR G HRGHGROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands.Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands., and M Maas.
• Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
• Br J Surg. 2021 Oct 23; 108 (10): 125112581251-1258.

BackgroundThe 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.MethodsIndividual-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).ResultsData 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.ConclusionRisk of nodal metastases (ypN+) after chemoradiotherapy increases with advancing ypT category and needs to be considered if an organ-preserving strategy is contemplated.© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please email: journals.permissions@oup.com.

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