ABSTRACT Background: To evaluate the relationship between the ratio of affected lymph nodes (LNR) and clinical and anatomopathological variables in patients with rectal adenocarcinoma submitted or not to neoadjuvant chemoradiotherapy. Methods: The LNR was determined by dividing the number of compromised LNR by the total number of LNR dissected in the surgical specimen. Patients were divided into two groups: with QRT and without QRT. In each group, the relationship between LNR and the following variables was evaluated: degree of cell differentiation, depth of invasion in the rectal wall, angiolymphatic /perineural invasion, degree of tumor regression and occurrence of metastases. The LNR was evaluated in patients with more than 1, LNR (LNR >12) or less (LNR<12) in the surgical specimen with overall survival (OS) and disease-free survival (DFS). The results were expressed as the mean with the respective standard deviation. Qualitative variables were analyzed using Fisher’s exact test, while quantitative variables were analyzed using the Kruskal -Wallis and Mann-Whitney tests. The significance level was 5%. Results: We evaluated 282 patients with QRT and 114 without QRT, between 1995-2011. In the QRT Group, LNR showed a significant association with mucinous tumors (P=0.007) and degree of tumor regression (P=0.003). In both groups, LNR was associated with poorly differentiated tumors (P=0.001, P=0.02), presence of angiolymphatic invasion (P<0.0001 and P=0.01), perineural (P=0.0007, P=0.02), degree of rectal wall invasion (T3>T2; P<0.0001, P=0.02); Compromised LNR (P<0.0001, P<0.01), metastases (P<0.0001, P<0.01). In patients with QRT, LNR<12 was associated with DFS (5.889; 95%CI1.935-19.687; P=0.018) and LNR>12 with DFS and OS (17.984; 95%CI5.931-54.351; P<0.001 and 10.286; 95%CI 2.654-39.854; P=0.007, respectively). Conclusion: LNR was associated with histological aspects of poor prognosis, regardless of the use of QRT. In the occurrence of less than 12 evaluated LNR, the LNR was associated only with the DFS. Background chemoradiotherapy Methods groups group differentiation 1 >12 LNR12 (LNR<12 (OS diseasefree disease free . (DFS) deviation Fishers Fisher s test Wallis MannWhitney Mann Whitney tests 5 5% Results 28 11 19952011. 19952011 1995 2011. 2011 1995-2011 Group P=0.007 P0007 P 0 007 (P=0.007 P=0.003. P0003 P=0.003 003 (P=0.003) P=0.001, P0001 001 (P=0.001 P=0.02, P002 P=0.02 , 02 P=0.02) P<0.0001 P00001 0001 (P<0.000 P=0.01, P001 P=0.01 01 P=0.01) P=0.0007, P00007 0007 (P=0.0007 T3>T2 T3T2 TT T3 T2 T (T3>T2 P<0.01, P<0.01 P<0.01) P<0.01. LNR<1 5.889 5889 889 (5.889 95%CI1.93519.687 95CI193519687 CI 95%CI1.935 19.687 95 CI1 935 19 687 95%CI1.935-19.687 P=0.018 P0018 018 LNR>1 17.984 17984 17 984 (17.984 95%CI5.93154.351 95CI593154351 95%CI5.931 54.351 CI5 931 54 351 95%CI5.931-54.351 P<0.00 10.286 10286 10 286 95CI 2.65439.854 265439854 2.654 39.854 2 654 39 854 2.654-39.854 respectively. respectively respectively) Conclusion prognosis >1 LNR1 (LNR<1 (DFS 1995201 199 201 1995-201 P=0.00 P000 00 (P=0.00 (P=0.003 P=0.001 P00 P=0.0 P<0.000 P0000 000 (P<0.00 P=0.0007 (P=0.000 T3>T T3T (T3>T P<0.0 LNR< 5.88 588 88 (5.88 93519 95%CI1.93519.68 95CI19351968 95CI1935 95%CI1.93 19687 19.68 9 93 68 95%CI1.935-19.68 LNR> 17.98 1798 98 (17.98 93154 95%CI5.93154.35 95CI59315435 95CI5931 95%CI5.93 54351 54.35 35 95%CI5.931-54.35 10.28 1028 65439 2.65439.85 26543985 2654 2.65 39854 39.85 65 3 85 2.654-39.85 > (LNR< 199520 20 1995-20 (P=0.0 P0 P=0. (P<0.0 P=0.000 P<0. 5.8 58 8 (5.8 9351 95%CI1.93519.6 95CI1935196 95CI193 95%CI1.9 1968 19.6 6 95%CI1.935-19.6 17.9 179 (17.9 9315 95%CI5.93154.3 95CI5931543 95CI593 95%CI5.9 5435 54.3 95%CI5.931-54.3 10.2 102 6543 2.65439.8 2654398 265 2.6 3985 39.8 2.654-39.8 19952 1995-2 (P=0. P=0 (P<0. P<0 5. (5. 95%CI1.93519. 95CI193519 95CI19 95%CI1. 196 19. 95%CI1.935-19. 17. (17. 95%CI5.93154. 95CI593154 95CI59 95%CI5. 543 54. 95%CI5.931-54. 10. 2.65439. 265439 26 2. 398 39. 2.654-39. 1995- (P=0 P= (P<0 P< (5 95%CI1.93519 95CI19351 95CI1 95%CI1 95%CI1.935-19 (17 95%CI5.93154 95CI59315 95CI5 95%CI5 95%CI5.931-54 2.65439 26543 2.654-39 (P= (P< ( 95%CI1.9351 95%CI1.935-1 (1 95%CI5.9315 95%CI5.931-5 2.6543 2.654-3 (P 95%CI1.935- 95%CI5.931- 2.654-
RESUMO Contexto: Avaliar a relação entre a razão de linfonodos (RLA) acometidos e variáveis clínicas e anatomopatológicas em portadores de adenocarcinoma de reto submetidos ou não à quimiorradioterapia neoadjuvante. Métodos: A RLA foi determinada dividindo-se o número total de linfonodos (LFNs) dissecados no espécime cirúrgico pelo número de comprometidos. Os doentes foram divididos em dois grupos: com QRT e sem QRT. Em cada grupo foi avaliada a relação entre a RLA e as seguintes variáveis: grau de diferenciação celular, profundidade de invasão na parede retal, invasão angiolinfática/perineural, grau de regressão tumoral e ocorrência de metástases. Avaliou-se a RLA em pacientes com mais do que 12 LFNs (RLA>12) ou menos (RLA<12) na peça cirúrgica com a sobrevida global (SG) e sobrevida livre de doença (SLD). Os resultados foram expressos pela média com o respectivo desvio padrão. As variáveis qualitativas foram analisadas utilizando-se o teste exato de Fisher, enquanto as quantitativas pelos testes de Kruskal-Wallis e Mann-Whitney. O nível de significância foi de 5%. Resultados: Foram avaliados 282 pacientes com QRT e 114 sem QRT, entre 1995-2011. No Grupo QRT, RLA mostrou associação significativa com os tumores mucinosos (P=0,007) e grau de regressão tumoral (P=0,003). Nos dois grupos, a RLA associou-se com tumores pouco diferenciados (P=0,001 e P=0,02), presença de invasão angiolinfática (P<0,0001 e P=0,01), perineural (P=0,0007 e P=0,02), grau de invasão da parede retal (T3>T2; P<0,0001 e P=0,02); LFNs comprometidos (P<0,0001 e P<0,01), metástases (P<0,0001 e P<0,01). Nos pacientes com QRT, a RLA <12 associou-se com a SLD (5,889; IC95%1,935-19,687; P=0,018) e a RLA >12 com SLD e SG (17,984; IC95%5,931-54,351; P<0,001 e 10,286; IC95%2,654-39,854; P=0,007, respectivamente). Conclusão: A RLA associou-se a aspectos histológicos de mau prognóstico, independentemente do emprego de QRT. Na ocorrência de menos de 12 LFNs avaliados, a RLA associou-se apenas com a SLD. Contexto (RLA neoadjuvante Métodos dividindose dividindo se (LFNs grupos celular angiolinfáticaperineural angiolinfática/perineural Avaliouse Avaliou 1 RLA>12 RLA12 (RLA>12 RLA<12 (RLA<12 (SG . (SLD) padrão utilizandose utilizando Fisher KruskalWallis Kruskal Wallis MannWhitney. MannWhitney Mann Whitney. Whitney Mann-Whitney 5 5% Resultados 28 11 19952011. 19952011 1995 2011. 2011 1995-2011 P=0,007 P0007 P 0 007 (P=0,007 P=0,003. P0003 P=0,003 003 (P=0,003) associouse associou P=0,001 P0001 001 (P=0,00 P=0,02, P002 P=0,02 , 02 P=0,02) P00001 0001 (P<0,000 P=0,01, P001 P=0,01 01 P=0,01) P=0,0007 P00007 0007 (P=0,000 T3>T2 T3T2 TT T3 T2 T (T3>T2 P<0,000 P<0,01, P<0,01 P<0,01) P<0,01. <1 5,889 5889 889 (5,889 IC95%1,93519,687 IC95193519687 IC IC95%1,935 19,687 IC95 935 19 687 IC95%1,935-19,687 P=0,018 P0018 018 >1 17,984 17984 17 984 (17,984 IC95%5,93154,351 IC95593154351 IC95%5,931 54,351 931 54 351 IC95%5,931-54,351 P<0,00 10,286 10286 10 286 IC95%2,65439,854 IC95265439854 IC95%2,654 39,854 2 654 39 854 IC95%2,654-39,854 respectivamente. respectivamente respectivamente) Conclusão prognóstico RLA>1 RLA1 (RLA>1 RLA<1 (RLA<1 (SLD 1995201 199 201 1995-201 P=0,00 P000 00 (P=0,003 (P=0,0 P00 P=0,0 P0000 000 (P<0,00 P=0,000 T3>T T3T (T3>T P<0,0 < 5,88 588 88 (5,88 93519 IC95%1,93519,68 IC9519351968 IC951935 IC95%1,93 19687 19,68 IC9 93 68 IC95%1,935-19,68 > 17,98 1798 98 (17,98 93154 IC95%5,93154,35 IC9559315435 IC955931 IC95%5,93 54351 54,35 35 IC95%5,931-54,35 10,28 1028 65439 IC95%2,65439,85 IC9526543985 IC952654 IC95%2,65 39854 39,85 65 3 85 IC95%2,654-39,85 RLA> (RLA> RLA< (RLA< 199520 20 1995-20 (P=0, P0 P=0, (P<0,0 P<0, 5,8 58 8 (5,8 9351 IC95%1,93519,6 IC951935196 IC95193 IC95%1,9 1968 19,6 9 6 IC95%1,935-19,6 17,9 179 (17,9 9315 IC95%5,93154,3 IC955931543 IC95593 IC95%5,9 5435 54,3 IC95%5,931-54,3 10,2 102 6543 IC95%2,65439,8 IC952654398 IC95265 IC95%2,6 3985 39,8 IC95%2,654-39,8 19952 1995-2 (P=0 P=0 (P<0, P<0 5, (5, IC95%1,93519, IC95193519 IC9519 IC95%1, 196 19, IC95%1,935-19, 17, (17, IC95%5,93154, IC95593154 IC9559 IC95%5, 543 54, IC95%5,931-54, 10, IC95%2,65439, IC95265439 IC9526 IC95%2, 398 39, IC95%2,654-39, 1995- (P= P= (P<0 P< (5 IC95%1,93519 IC9519351 IC951 IC95%1 IC95%1,935-19 (17 IC95%5,93154 IC9559315 IC955 IC95%5 IC95%5,931-54 IC95%2,65439 IC9526543 IC952 IC95%2 IC95%2,654-39 (P (P< ( IC95%1,9351 IC95% IC95%1,935-1 (1 IC95%5,9315 IC95%5,931-5 IC95%2,6543 IC95%2,654-3 IC95%1,935- IC95%5,931- IC95%2,654-