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Concordance between clinical and pathologic assessment of T and N stages of rectal adenocarcinoma patients who underwent surgery without neoadjuvant therapy: A National Cancer Database analysis

  • Sameh Hany Emile
    Affiliations
    Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA

    Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
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  • Emanuela Silva-Alvarenga
    Affiliations
    Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA
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  • Nir Horesh
    Affiliations
    Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA

    Department of Surgery and Transplantation, Sheba Medical Center, Ramat Gan, Tel Aviv University, Tel Aviv, Israel
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  • Michael R. Freund
    Affiliations
    Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA

    Department of General Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
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  • Zoe Garoufalia
    Affiliations
    Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA
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  • Steven D. Wexner
    Correspondence
    Corresponding author. Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA.
    Affiliations
    Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA
    Search for articles by this author
Published:September 30, 2022DOI:https://doi.org/10.1016/j.ejso.2022.09.014

      Abstract

      Background

      Clinical assessment of T and N stages in rectal cancer is important to guide decision-making. The present study aimed to assess the accuracy of the clinical T and N staging of rectal cancer compared to the pathological staging and their overall agreement in a large cohort of patients.

      Methods

      This retrospective study used data from the National Cancer Database (NCDB) between 2004 and 2017. Patients with non-metastatic rectal adenocarcinoma who did not receive neoadjuvant therapy were reviewed and the clinical T and N stages were compared to their pathologic counterparts. The overall concordance between clinical and pathologic assessments was calculated using Kappa coefficient.

      Results

      The study included 8929 patients (57.3% male) with a mean age of 64 years. Clinical T stage and N stage were identical to pathologic stages in 70.3% and 77.6% of patients, respectively. Sensitivity and specificity of the clinical assessment of N stage was 35.2% and 95.5%, respectively. Concordance between the clinical and pathologic stages was moderate for the T stage (kappa = 0.575) and fair for the N stage (kappa = 0.346). Pathologic T4 stage (OR: 2.12, p < 0.0001), poorly differentiated adenocarcinoma (OR: 1.45, p = 0.026), lymphovascular invasion (OR: 4.5, p < 0.001), and longer time from diagnosis to first treatment (OR = 0.996, p = 0.046) were the independent predictors of N stage discrepancy.

      Conclusions

      There was a moderate agreement between the clinical and pathologic T stages and a fair agreement between the clinical and pathologic N stages. The clinical assessment of the N stage was highly specific yet had low sensitivity.

      Keywords

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      References

        • Keller D.S.
        • Berho M.
        • Perez R.O.
        • Wexner S.D.
        • Chand M.
        The multidisciplinary management of rectal cancer. Nat.
        Rev Gastroenterol Hepatol. 2020; 17: 414-429
        • Compton C.
        • Fenogliopreiser C.M.
        • Pettigrew N.
        • et al.
        American Joint Committee on Cancer prognostic factors consensus conference: colorectal working group.
        J Cancer. 1999; 86: 2436
        • Zhang Chundong
        • Mei Zubing
        • et al.
        A modified tumor-node-metastasis classification for primary operable colorectal cancer. vol. 5. JNCI Cancer Spectr, 2020 (pkaa093)
        • Nagtegaal I.
        • Gaspar C.
        • Marijnen C.
        • Van De Velde C.
        • Fodde R.
        • Van Krieken H.
        Morphological changes in tumour type after radiotherapy are accompanied by changes in gene expression profile but not in clinical behaviour.
        J Pathol. 2004; 204: 183-192
        • Suzuki C.
        • Torkzad M.R.
        • Tanaka S.
        • et al.
        The importance of rectal cancer MRI protocols on interpretation accuracy.
        World J Surg Oncol. 2008; 6: 89
        • Patel U.B.
        • Taylor F.
        • Blomqvist L.
        • et al.
        Magnetic resonance imaging-detected tumor response for locally advanced rectal cancer predicts survival outcomes: MERCURY experience.
        J Clin Oncol. 2011; 29: 3753-3760
        • Taylor F.G.
        • Swift R.I.
        • Blomqvist L.
        • Brown G.
        A systematic approach to the interpretation of preoperative staging MRI for rectal cancer.
        AJR Am J Roentgenol. 2008; 191: 1827-1835
        • National Comprehensive Cancer Network
        Clinical practice guidelines in oncology (NCCN Guidelines): colon cancer—version 1.
        Published, 2018 (2018)
        • Hernández Benitez J.
        • Camacho Elizondo K.
        • de la Cruz de la Cruz C.
        • Gallegos Arguijo D.
        • Ruiz Sánchez D.
        • Hernández Barajas D.
        Accuracy of clinical staging for rectal cancer.
        Ann Oncol. 2019; 30https://doi.org/10.1093/annonc/mdz155.176
        • Kim N.K.
        • Kim M.J.
        • Park J.K.
        • Park S.I.
        • Min J.S.
        Preoperative staging of rectal cancer with MRI: accuracy and clinical usefulness.
        Ann Surg Oncol. 2000; 7: 732-737
        • Videhult P.
        • Smedh K.
        • Lundin P.
        • Kraaz W.
        Magnetic resonance imaging for preoperative staging of rectal cancer in clinical practice: high accuracy in predicting circumferential margin with clinical benefit.
        Colorectal Dis. 2007; 9: 412-419
        • Kanda Y.
        Investigation of the freely available easy-to-use software 'EZR' for medical statistics.
        Bone Marrow Transplant. 2013; 48: 452-458
        • Jalilian M.
        • Davis S.
        • Mohebbi M.
        • et al.
        Pathologic response to neoadjuvant treatment in locally advanced rectal cancer and impact on outcome.
        J Gastrointest Oncol. 2016; 7: 603-608
        • Harisi R.
        • Schaff Z.
        • Flautner L.
        • et al.
        Evaluation and comparison of the clinical, surgical and pathological TNM staging of colorectal cancer.
        Hepato-Gastroenterology. 2008; 55: 66-72
        • Magri K.D.
        • Bin F.C.
        • Formiga F.B.
        • et al.
        Impact of neoadjuvant therapy in downstaging of lower rectal adenocarcinoma and the role of pelvic magnetic resonance in staging.
        Rev Col Bras Cir. 2016; 43: 102-109
        • Kim J.H.
        • Beets G.L.
        • Kim M.J.
        • Kessels A.G.
        • Beets-Tan R.G.
        High-resolution MR imaging for nodal staging in rectal cancer: are there any criteria in addition to the size?.
        Eur J Radiol. 2004; 52: 78-83
        • Brown G.
        • Richards C.J.
        • Bourne M.W.
        • et al.
        Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison.
        Radiology. 2003; 227: 371-377
        • Ha R.K.
        • Han K.S.
        • Sohn D.K.
        • et al.
        Histopathologic risk factors for lymph node metastasis in patients with T1 colorectal cancer.
        Ann Surg Treat Res. 2017; 93: 266-271
        • Zhang Q.
        • Wang L.
        • Huang D.
        • et al.
        Pathological risk factors for lymph node metastasis in patients with submucosal invasive colorectal carcinoma.
        Cancer Manag Res. 2019; 11: 1107-1114
        • Carrara A.
        • Mangiola D.
        • Pertile R.
        • et al.
        Analysis of risk factors for lymph nodal involvement in early stages of rectal cancer: when can local excision be considered an appropriate treatment? Systematic review and meta-analysis of the literature.
        Int J Surg Oncol. 2012; 2012438450
        • Scheele J.
        • Schmidt S.A.
        • Tenzer S.
        • Henne-Bruns D.
        • Kornmann M.
        Overstaging. A challenge in rectal cancer treatment.
        Vis Med. 2018; 34: 301-306
        • Beets-Tan R.G.H.
        • Lambregts D.M.J.
        • Maas M.
        • et al.
        Magnetic resonance imaging for clinical management of rectal cancer: updated recommendations from the 2016 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting.
        Eur Radiol. 2018; 34: 1465-1475