{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T17:24:27Z","timestamp":1785000267216,"version":"3.55.0"},"reference-count":27,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004622","name":"KWF Kankerbestrijding","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004622","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>In rectal cancer, neo\u2010adjuvant (chemo)radiotherapy (n(C)RT) should be used selectively, due to related toxicity. The decision to offer n(C)RT is mainly based on preoperative MRI staging. cN category has limited accuracy and its use when deciding on n(C)RT is controversial. This population\u2010based study aimed to assess the association between cN category and local recurrence (LR) rate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Data from a national cross\u2010sectional cohort of patients who underwent curative resection of primary rectal cancer in the Netherlands in 2016 were used. Patients were subdivided by neo\u2010adjuvant treatment strategy: no n(C)RT, short\u2010course RT with short interval to surgery (SCRT\u2010SI) or downstaging therapy (SCRT with long interval to surgery, CRT, total neoadjuvant therapy or chemotherapy only). The 4\u2010year LR rate was calculated per (y)cN category and corrected for known pre\u2010operative confounders in Cox\u2010regression analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 2148 included patients, 1000 received no n(C)RT, 449 SCRT\u2010SI and 699 downstaging therapy. Median follow\u2010up was 50\u2009months (interquartile range [IQR] 38\u201355). The 4\u2010year LR rates for cN0, cN1 and cN2 were 6.3%, 5.0% and 6.2% without n(C)RT, and 0%, 2.4% and 0% after SCRT\u2010SI. In patients treated with downstaging therapy, not primary cN, but restaging ycN category was significantly associated with LR rate (9.1%, 17.4% and 18.5%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006) in univariable analysis. In multivariable analysis, no association was observed between ycN and LR (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.088).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Evaluation of nationwide clinical practice did not reveal significant associations between cN category and LR rate after rectal cancer resection within three neo\u2010adjuvant treatment groups, which questions its validity for clinical decision\u2010making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/codi.70257","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T03:31:09Z","timestamp":1759980669000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical nodal staging to assess the risk of local recurrence after rectal cancer resection: A nationwide cross\u2010sectional study"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6764-572X","authenticated-orcid":false,"given":"Mirthe","family":"Ubink","sequence":"first","affiliation":[{"name":"Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute University Medical Center Rotterdam  Rotterdam The Netherlands"},{"name":"Department of Medical Oncology, Erasmus MC Cancer Institute University Medical Center Rotterdam  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eline G. M.","family":"van Geffen","sequence":"additional","affiliation":[{"name":"Department of Surgery Amsterdam UMC Location Vrije Universiteit Amsterdam  Amsterdam The Netherlands"},{"name":"Cancer Center Amsterdam, Treatment and Quality of Life and Imaging and Biomarkers  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania C.","family":"Sluckin","sequence":"additional","affiliation":[{"name":"Department of Surgery Amsterdam UMC Location Vrije Universiteit Amsterdam  Amsterdam The Netherlands"},{"name":"Cancer Center Amsterdam, Treatment and Quality of Life and Imaging and Biomarkers  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanne\u2010Marije J. A.","family":"Hazen","sequence":"additional","affiliation":[{"name":"Department of Surgery Amsterdam UMC Location Vrije Universiteit Amsterdam  Amsterdam The Netherlands"},{"name":"Cancer Center Amsterdam, Treatment and Quality of Life and Imaging and Biomarkers  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Horsthuis","sequence":"additional","affiliation":[{"name":"Cancer Center Amsterdam, Treatment and Quality of Life and Imaging and Biomarkers  Amsterdam The Netherlands"},{"name":"Department of Radiology and Nuclear Medicine Amsterdam UMC Location Vrije Universiteit Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joost","family":"Nederend","sequence":"additional","affiliation":[{"name":"Department of Radiology Catharina Hospital  Eindhoven The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regina G. H.","family":"Beets\u2010Tan","sequence":"additional","affiliation":[{"name":"Department of Radiology The Netherlands Cancer Institute  Amsterdam The Netherlands"},{"name":"GROW School for Oncology and Developmental Biology University of Maastricht  Maastricht The Netherlands"},{"name":"Department of Radiology, Department of Clinical Research Odense University Hospital, University of Southern Denmark  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martijn P. W.","family":"Intven","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Utrecht University Medical Centre  Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelis","family":"Verhoef","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute University Medical Center Rotterdam  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2468-9186","authenticated-orcid":false,"given":"Miranda","family":"Kusters","sequence":"additional","affiliation":[{"name":"Department of Surgery Amsterdam UMC Location Vrije Universiteit Amsterdam  Amsterdam The Netherlands"},{"name":"Cancer Center Amsterdam, Treatment and Quality of Life and Imaging and Biomarkers  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3146-3310","authenticated-orcid":false,"given":"Pieter J.","family":"Tanis","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute University Medical Center Rotterdam  Rotterdam The Netherlands"},{"name":"Cancer Center Amsterdam, Treatment and Quality of Life and Imaging and Biomarkers  Amsterdam The Netherlands"},{"name":"Department of Surgery Amsterdam UMC Location University of Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Dutch Snapshot Research Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,8]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2168.2002.02196.x"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000257358.56863.ce"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.136.2.216"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa040694"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.23.01208"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/02841860701348670"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2022.07.003"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.14.779"},{"key":"e_1_2_12_10_1","unstructured":"NICE Guideline Colorectal Cancer.2020. 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