To the Editor: How Do We Solve This Confusion?

Dear Editor,

We read with great interest the article titled “Neoadjuvant Therapy for Rectal Cancer Affects Lymph Node Yield and Status Without Clear Implications on Outcome: The Case for Eliminating a Metric and Using Preoperative Staging to Guide Therapy” by Abdel-Misih et al.1 We came across another article on a similar topic,2 but with conflicting conclusions.

In their study, based on the National Cancer Database (NCDB), Abdel-Misih et al concluded that nodal yield in rectal cancer is multifactorial, and that node yield and status were not significant predictors of overall survival (OS). Thus, nodal metric may not be clinically relevant in the era of neoadjuvant therapy. Conversely, the other article2 stated that their study, also based on the NCDB, clearly demonstrated that lymph node yield is associated with OS in stage I–III rectal cancer, independent of neoadjuvant therapy.

In rectal cancer, neoadjuvant therapy combinations are considered the standard of care, with variations in approach depending on the center.3,4 But these 2 different results based on the same database are confusing. Can the authors clarify these 2 contradictory results?


Mesut Tez, MD

Baris Yildiz, MD

Sabri Ozden, MD

Ankara Numune Teaching Hospital, Turkey

Call for Correspondence

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  • 1.

    Abdel-Misih SR, Wei L, Benson AB III. Neoadjuvant therapy for rectal cancer affects lymph node yield and status without clear implications on outcome: the case for eliminating a metric and using preoperative staging to guide therapy. J Natl Compr Canc Netw 2016;12:15281534.

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  • 2.

    Xu Z, Berho ME, Becerra AZ. Lymph node yield is an independent predictor of survival in rectal cancer regardless of receipt of neoadjuvant therapy. J Clin Pathol 2017;70:584592.

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  • 3.

    Millard T, Kunk PR, Ramsdale E, Rahma OE. Current debate in the oncologic management of rectal cancer. World J Gastrointest Oncol 2016;8:715724.

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  • 4.

    Schrag D. Evolving role of neoadjuvant therapy in rectal cancer. Curr Treat Options Oncol 2013;14:350364.

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