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Clinical Aspects: Colorectal Cancer

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Lymph Node Metastasis in Gastrointestinal Cancer

Abstract

Colorectal cancer (CRC) is one of the most common cancers worldwide. Currently, postoperative adjuvant chemotherapy is recommended for node-positive stage III patients, but not for those who are node-negative, with stage II disease. However, a systematic meta-analysis revealed that the presence of micrometastases in regional lymph nodes (LNs) was associated with poor survival in 4087 patients with node-negative CRC. Unfortunately, the majority of studies used in that meta-analysis were performed retrospectively. In a prospective clinical trial, we revealed that the micrometastasis volume, as determined by qRT-PCR of carcinoembryonic antigen (CEA) mRNA, is a useful marker with which to stratify patients at risk of recurrence of stage II CRC. Furthermore, our quantitative data illustrated the concept that stage II CRC represents a transitional stage between localized (stage I) and a more expansive (stage III) disease. At the cellular level, the intermediary stage II disease involves CRC tumors that continuously “seed” micrometastases in LNs, which then increases the risk of tumor recurrence.

The one-step nucleic acid amplification (OSNA) assay is a novel and rapid technique with which to detect cytokeratin (CK) 19 mRNA using reverse transcription loop-mediated isothermal amplification (RT-LAMP). Using OSNA, a prospective study showed that rates of upstaging in 124 node-negative patients (pN0) with pStages I, IIA, IIB, and IIC were 2.0%, 17.7%, 12.5%, and 25%, respectively. These findings suggest that OSNA may usefully substitute for RT-PCR of CEA mRNA owing to its ease of use and rapidity.

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Authors and Affiliations

  1. Department of Surgery, Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan

    Hirofumi Yamamoto & Masaki Mori

  2. Division of Health Sciences, Department of Molecular Pathology, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan

    Hirofumi Yamamoto

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  1. Hirofumi Yamamoto
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  2. Masaki Mori
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Correspondence to Hirofumi Yamamoto .

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Editors and Affiliations

  1. Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima, Japan

    Shoji Natsugoe

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Yamamoto, H., Mori, M. (2019). Clinical Aspects: Colorectal Cancer. In: Natsugoe, S. (eds) Lymph Node Metastasis in Gastrointestinal Cancer. Springer, Singapore. https://doi.org/10.1007/978-981-10-4699-5_11

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  • DOI: https://doi.org/10.1007/978-981-10-4699-5_11

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