Abstract
The quality of pathologic assessment of rectal cancer specimens is crucial for treatment efficiency and survival. The Royal College of Pathologists (RCP) recommends evaluating the quality of the pathology report in routine practice using three quality indicators (QIs): the number of lymph nodes (LNs) analyzed (≥ 12), the rate of venous invasion (VI ≥ 30%), and peritoneal involvement (pT4a ≥ 10%). In this study, we evaluated the three QIs of the French national pathology reports and compared them with British guidelines and assessed the influence of neoadjuvant radiochemotherapy on QIs. From January 1 to December 31, 2016, all pathology reports for rectal adenocarcinoma were collected from French departments. Neoadjuvant radiochemotherapy included long-course radiotherapy with concomitant 5-FU-based chemotherapy. A total of 983 rectal cancer pathology reports were evaluated. A median of 15 LNs were analyzed and 81% of centers had ≥ 12 LNs. The rate of VI was 30% and 41% of centers had ≥ 30% VI. The rate of pT4a was 4% and 18% of centers reported ≥ 10% pT4a. None of the centers reached the threshold for the three QIs. All three QIs were lower after radiochemotherapy compared to surgery alone. In conclusion, in French routine practice, the values of two of the three QIs (LNs analyzed and VI) were globally in line with RCP guidelines. However, the rate of pT4a was very low, particularly after radiochemotherapy, suggesting its low value in rectal cancer.
Similar content being viewed by others
References
Choix des thérapeutiques du cancer du rectum. Recommandations pour la pratique clinique - Novembre 2005. (2006) Gastroenterol Clin Biol 30:59–69. https://www.has-sante.fr/portail/upload/docs/application/pdf/Cancer_rectum_recos.pdf. Accessed 03 Jan 2019
Mise à jour 2011 des comptes-rendus d'anatomopathologie: données minimales à renseigner pour une tumeur primitive. Traitements, soins et innovations, INCa, Boulogne-Billancourt. http://www.sfpathol.org/media/pdf/item-minim-actualis-2012-1.pdf. Accessed 18 Oct 2018
Bridoux V, de Chaisemartin C, Beyer L, Goasguen N, Sabbagh C, Guedj N, Dartigues P, Bardier A (2016) Recommandations pour la pratique clinique. Cancer du rectum. Question 2: Quels sont les critères de qualité de l'exérèse chirurgicale ? Côlon and Rectum 10:12–27
Loughrey MB, Quirke P, Shepherd NA (2014) Standards and datasets for reporting cancers Dataset for colorectal cancer histopathology reports. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=2ahUKEwjsgdCMuI_eAhXOesAKHfCeBIAQFjABegQIBxAC&url=https%3A%2F%2Fwww.rcpath.org%2Fasset%2FC8B61BA0-AE3F-43F1-85FFD3AB9F17CFE6.7F4D0A7A-A547-4D5C-9A7C50045817CCF0%2F&usg=AOvVaw2x0I4jJJqoWQy8WL1d510A. Accessed 18 Oct 2018
Loughrey MB, Quirke P, Shepherd NA (2017) Standards and datasets for reporting cancers. Dataset for colorectal cancer histopathology reports. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=2ahUKEwjsgdCMuI_eAhXOesAKHfCeBIAQFjAAegQICBAC&url=https%3A%2F%2Fwww.rcpath.org%2Fasset%2FE94CE4A2-D722-44A7-84B9D68294134CFC%2F&usg=AOvVaw1SSm79PMvUnyEDdeV6JrqK. Accessed 18 Oct 2018
Loughrey MB, Quirke P, Shepherd NA (2018) Standards and datasets for reporting cancers. Dataset for colorectal cancer histopathology reports. https://www.rcpath.org/uploads/assets/uploaded/0d5e22ce-be66-474c-ba3097adae84121d.pdf. Accessed 03 Jan 2019
Swanson RS, Compton CC, Stewart AK, Bland KI (2003) The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Oncol 10:65–71. https://doi.org/10.1245/ASO.2003.03.058
Morris EJA, Maughan NJ, Forman D, Quirke P (2007) Identifying stage III colorectal cancer patients: the influence of the patient, surgeon, and pathologist. J Clin Oncol 25:2573–2579. https://doi.org/10.1200/JCO.2007.11.0445
Brierley JD, Gospodarowicz MK, Wittekinf C (eds) (2017) TNM classification of malignant tumors, 8th edn. Wiley-Blackwell, Oxford
Lim S-B, Yu CS, Jang SJ, Kim TW, Kim JH, Kim JC (2010) Prognostic significance of lymphovascular invasion in sporadic colorectal cancer. Dis Colon Rectum 53:377–384. https://doi.org/10.1007/DCR.0b013e3181cf8ae5
Sanjay Kakar, Chanjuan Shi, Mariana E, et al. (2017) Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum. http://www.cap.org/ShowProperty?nodePath=/UCMCon/Contribution%20Folders/WebContent/pdf/cp-colon-17protocol-4001.pdf. Accessed 18 Oct 2018
Puppa G, Maisonneuve P, Sonzogni A, Masullo M, Capelli P, Chilosi M, Menestrina F, Viale G, Pelosi G (2007) Pathological assessment of pericolonic tumor deposits in advanced colonic carcinoma: relevance to prognosis and tumor staging. Mod Pathol 20:843–855. https://doi.org/10.1038/modpathol.3800791
Shepherd NA, Baxter KJ, Love SB (1997) The prognostic importance of peritoneal involvement in colonic cancer: a prospective evaluation. Gastroenterology 112:1096–1102
Lefevre JH, Mineur L, Kotti S, Rullier E, Rouanet P, de Chaisemartin C, Meunier B, Mehrdad J, Cotte E, Desrame J, Karoui M, Benoist S, Kirzin S, Berger A, Panis Y, Piessen G, Saudemont A, Prudhomme M, Peschaud F, Dubois A, Loriau J, Tuech JJ, Meurette G, Lupinacci R, Goasgen N, Parc Y, Simon T, Tiret E (2016) Effect of interval (7 or 11 weeks) between neoadjuvant radiochemotherapy and surgery on complete pathologic response in rectal cancer: a multicenter, randomized, controlled trial (GRECCAR-6). J Clin Oncol 34:3773–3780. https://doi.org/10.1200/JCO.2016.67.6049
Nagtegaal ID, van de Velde CJH, van der Worp E, Kapiteijn E, Quirke P, van Krieken J, Han JM (2002) Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 20:1729–1734. https://doi.org/10.1200/JCO.2002.07.010
Sobin L, Gospodarowicz M, Wittekind C (eds) (2009) TNM classification of malignant tumours, 7th edn. Wiley-Blackwell, Oxford
Dworak O, Keilholz L, Hoffmann A (1997) Pathological features of rectal cancer after preoperative radiochemotherapy. Int J Color Dis 12:19–23
Rödel C, Martus P, Papadoupolos T, Füzesi L, Klimpfinger M, Fietkau R, Liersch T, Hohenberger W, Raab R, Sauer R, Wittekind C (2005) Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 23:8688–8696. https://doi.org/10.1200/JCO.2005.02.1329
Glimelius B, Tiret E, Cervantes A, Arnold D (2013) Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 24:vi81–vi88. https://doi.org/10.1093/annonc/mdt240
Quirke P (2003) Training and quality assurance for rectal cancer: 20 years of data is enough. Lancet Oncol 4:695–702
Li Q, Liang L, Gan L, Cai G, Li X, Cai S (2015) Effect of lymph node count on pathological stage III rectal cancer with preoperative radiotherapy. Sci Rep. https://doi.org/10.1038/srep16990
Elferink MAG, Siesling S, Lemmens VEPP, Visser O, Rutten HJ, van Krieken JHJM, Tollenaar RAEM, Langendijk JA (2011) Variation in lymph node evaluation in rectal cancer: a Dutch nationwide population-based study. Ann Surg Oncol 18:386–395. https://doi.org/10.1245/s10434-010-1269-8
Mechera R, Schuster T, Rosenberg R, Speich B (2017) Lymph node yield after rectal resection in patients treated with neoadjuvant radiation for rectal cancer: a systematic review and meta-analysis. Eur J Cancer 72:84–94. https://doi.org/10.1016/j.ejca.2016.10.031
Rullier A, Laurent C, Capdepont M, Vendrely V, Belleannée G, Bioulac-Sage P, Rullier E (2008) Lymph nodes after preoperative chemoradiotherapy for rectal carcinoma: number, status, and impact on survival. Am J Surg Pathol 32:45–50
Scheel AH, Reineke RA, Sprenger T, Lokka S, Kitz J, Ghadimi BM, Rüschoff J, Liersch T, Middel P (2015) Comprehensive lymph node morphometry in rectal cancer using acetone compression. J Clin Pathol 68:458–464. https://doi.org/10.1136/jclinpath-2014-202555
Lindboe CF (2011) Lymph node harvest in colorectal adenocarcinoma specimens: the impact of improved fixation and examination procedures: lymph node harvest in colorectal cancer. APMIS 119:347–355. https://doi.org/10.1111/j.1600-0463.2011.02748.x
Messenger DE, Driman DK, Kirsch R (2012) Developments in the assessment of venous invasion in colorectal cancer: implications for future practice and patient outcome. Hum Pathol 43:965–973. https://doi.org/10.1016/j.humpath.2011.11.015
Yu SKT, Tait D, Chau I, Brown G (2013) MRI predictive factors for tumor response in rectal cancer following neoadjuvant chemoradiation therapy—implications for induction chemotherapy? Int J Radiat Oncol Biol Phys 87:505–511. https://doi.org/10.1016/j.ijrobp.2013.06.2052
Nagtegaal ID, Quirke P (2008) What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 26:303–312. https://doi.org/10.1200/JCO.2007.12.7027
Rullier A, Gourgou-Bourgade S, Jarlier M, Bibeau F, Chassagne-Clément C, Hennequin C, Tisseau L, Leroux A, Ettore F, Peoc’h M, Diebold MA, Robin YM, Kleinclaus I, Mineur L, Petitjean C, Mosnier JF, Soubeyran I, Padilla N, Lemaistre AI, Bérille J, Denis B, Conroy T, Gérard JP (2013) Predictive factors of positive circumferential resection margin after radiochemotherapy for rectal cancer: the French randomised trial ACCORD12/0405 PRODIGE 2. Eur J Cancer 49:82–89. https://doi.org/10.1016/j.ejca.2012.06.028
Acknowledgments
The authors thank Pr E Rullier for the revision of the manuscript.
Contribution statement
C Boutanos and A Rullier conceived and designed the study and wrote, edited, and reviewed the manuscript. C Boutanos and M Capdepont researched and analyzed data. All authors gave the final approval for publication. A Rullier takes full responsibility for the work as a whole, including the study design, access to data, and the decision to submit and publish the manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
In this work, all pathology reports were anonymized before analysis. Therefore, no informed consent was obtained.
Conflict of interest
The authors declare that they have no conflicts of interest.
Additional information
The English in this document has been checked by at least two professional editors, both native speakers of English. For a certificate, please see: http://www.textcheck.com/certificate/KsG01g.
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
ESM 1
(DOC 78 kb)
Rights and permissions
About this article
Cite this article
Boutanos, C., Capdepont, M., Svrcek, M. et al. National multicentric evaluation of quality of pathology reports for rectal cancer in France in 2016. Virchows Arch 474, 561–568 (2019). https://doi.org/10.1007/s00428-019-02534-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00428-019-02534-8