Advertisement

Clinical and Translational Oncology

, Volume 10, Issue 9, pp 572–578 | Cite as

Prognostic value of the detection of lymph node micrometastases in colon cancer

  • Carlos E. Bosch RoigEmail author
  • Ester Roselló-Sastre
  • Sonia Alonso Hernández
  • Daniel Almenar Cubells
  • Enrique Grau Cardona
  • Natalia Camarasa Lillo
  • Daniel Bautista
  • Carmen Molins Palau
Research Articles

Abstract

Introduction and objectives

A study is made of the clinical repercussions of occult metastases-micrometastases (MMs+)-or isolated tumour cells (ITCs+) in the lymph nodes of patients with stage IIA and IIB colon adenocarcinoma initially considered as corresponding to N0.

Material and methods

A retrospective study of 39 patients with stage IIA and IIB (T3–T4 N0 M0) colon adenocarcinoma, subjected to similar surgical and adjuvant chemotherapy treatment, with long and careful follow-up (minimum: 5 years, mean: 81.7 months) was performed on their previously resected lymph nodes, with the aid of new histological and immunohistochemical (cytokeratin) sections, in order to detect MMs or ITCs. Disease-free survival (DFS) and global survival (GS) in the two groups (patients with MMs+ or ITCs+ vs. patients without MMs or ITCs) were compared at 5 years based on the corresponding Kaplan-Meier survival curves, with the Breslow test.

Results

A total of 382 lymph nodes from the 39 patients (mean: 9.8; standard deviation: 6.09) were revised. MMs+ were detected in 2 cases and ITCs+ in 2 more cases on the Cytokeratin study. GS of the whole series at 5 years was 89.74% (35 patients alive) with a DFS at 5 years of 79.49% (31 patients free of disease), but the 2 cases with MMs+ were dead at 5 years, with high statistical differences between both groups (MMs+/MMs−) (p<0.0001). When comparing the group of MMs+/ITCs+ patients and the group of MM−/ITCs− patients, the DFS and GS times at 5 years were higher in the MMs−/ITCs− group (p=0.0692 and p=0.006 respectively).

Conclusions

Although the incidence of MMs+ or ITCs+ in the examined lymph nodes was low, the presence of MMs is related to a dramatic reduction in GS and DFS at 5 years. We encourage a detailed histological study of lymph nodes resected in patients with deep penetrating colon tumours in order to assure a pN0 status.

Keywords

Colon cancer Micrometastases Lymph nodes Global survival Disease-free survival 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    NIH Consensus Conference (1990) Adjuvant for patients with colon and rectal. JAMA 264:1444–1450CrossRefGoogle Scholar
  2. 2.
    Nauta R, Stablein DM, Holyoke ED (1989) Survival of patients with stage B2 colon carcinoma. The Gastrointestinal Tumor Study Group experience. Arch Surg 124:180–182PubMedGoogle Scholar
  3. 3.
    Compton C, Green F (2004) The staging of colorectal cancer: 2004 and beyond. CA Cancer J Clin 54:295–308PubMedCrossRefGoogle Scholar
  4. 4.
    Benson AB 3rd, Schrag D, Somerfield MR et al (2004) American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol 22:3408–3419PubMedCrossRefGoogle Scholar
  5. 5.
    Broun HG, Lukasevic TM, Medich DS et al (2004) Efficacy of manual dissection of lymph nodes in colon cancer resections. Mod Pathol 17:402–406CrossRefGoogle Scholar
  6. 6.
    Bertoglio S, Sandrucci S, Percivale P et al (2004) Prognostic value of sentinel lymph node biopsy in the pathologic staging of colorectal cancer patients. J Surg Oncol 85:166–170PubMedCrossRefGoogle Scholar
  7. 7.
    Palma RT, Waisberg J, Bromberg SH et al (2003) Micrometastasis in regional lymph nodes of extirpated colorectal carcinoma: immunohistochemical study using anti-cytokeratin antibodies AE1/AE3. Colorectal Dis 5:164–168PubMedCrossRefGoogle Scholar
  8. 8.
    Liefers GJ, Cleton-Jansen AM, van de Velde CJ et al (1998) Micrometastases and survival in stage II colorectal cancer. N Engl J Med 339:223–228PubMedCrossRefGoogle Scholar
  9. 9.
    Moertel CG, Fleming TR, Macdonald JS et al (1995) Fluorouracil plus levamisole as effective adjuvant therapy after resection of stage III colon carcinoma: a final report. Ann Intern Med 122: 321–326PubMedGoogle Scholar
  10. 10.
    Haller DG, Catalano PJ, Macdonald JS, Mayer RJ (1998) Fluorouracil, leucovorin and levamisole adjuvant therapy for colon cancer: five years final report of inter-0089. Proc Am Soc Clin Oncol 17:982 (abstr)Google Scholar
  11. 11.
    Singletray SE, Greene FL, Sobin LH (2003) Classification of isolated tumors cells: clarification of the 6th edition of the American Joint Committee on Cancer Staging Manual. Cancer 98:2740–2741CrossRefGoogle Scholar
  12. 12.
    Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481CrossRefGoogle Scholar
  13. 13.
    Cox DR (1972) Regression models and life-tables. J R Stat Soc [B] 34:187–220Google Scholar
  14. 14.
    Wong J, Severino R, Barbera M et al (1999) Number of nodes examined and staging accuracy in colorectal carcinoma. J Clin Oncol 17:2896–2900PubMedGoogle Scholar
  15. 15.
    Baxter NN, Virgin DJ, Rothenberger DA et al (2005) Lymph node evaluation in colorectal cancer patients: a population-based study. J Natl Cancer Inst 97:219–225PubMedCrossRefGoogle Scholar
  16. 16.
    Green FL, Page DL, Fleming ID et al (eds) (2002) AJCC cancer staging manual, 6th Edn. Springer, New York, NYGoogle Scholar
  17. 17.
    Yasuda K, Adachi Y, Shiraishi N et al. Pattern of lymph node micrometastasis and prognosis of patients with colorectal cancer. Ann Surg Oncol 8:300–304Google Scholar
  18. 18.
    Haboubi NT, Abdalla SA, Amini S et al (1998) The novel combination of fat clearance and immunochemistry improves prediction of the outcome of patients with colorectal carcinomas: a preliminary study. Int J Colorectal Dis 13:99–102PubMedCrossRefGoogle Scholar
  19. 19.
    Adell G, Boeryd B, Franiund R et al (1996) Occurrence and prognostic importance of micrometastases in regional lymph nodes in Dukes’ B colorectal carcinoma: an immunohistochemical study. Eur J Surg 162:637–642PubMedGoogle Scholar
  20. 20.
    Greenson JK, Isenhart CE, Rice R et al (1994) Identification of occult micrometastases in pericolic lymph nodes of Duke’s B colorectal cancer patients using monoclonal antibodies against cytokeratin and CC49. Correlation with long-term survival. Cancer 73:563–569PubMedCrossRefGoogle Scholar
  21. 21.
    Jeffers MD, O’Dowd GM, Mulcahy H et al (1994) The prognostic significance of immunohistochemically detected lymph node micrometastases in colorectal carcinoma. J Pathol 172:183–187PubMedCrossRefGoogle Scholar
  22. 22.
    Broll R, Schauer V, Schimmelpenning H et al (1997) Prognostic relevance of occult tumor cells in lymph nodes of colorectal carcinomas. Dis Colon Rectum 40:1465–1471PubMedCrossRefGoogle Scholar
  23. 23.
    Cutait R, Alves VA, Lopez LC et al (1991) Restaging of colorectal cancer based on the identification of lymph node micrometastasis through immunoperoxidase staining of CEA and cytokeratins. Dis Colon Rectum 34:917–920PubMedCrossRefGoogle Scholar
  24. 24.
    Oberg A, Stenling R, Taveling B, Lindmark G (1998) Are lymph node micrometastasis of any clinical significance in Dukes stages A and B colorectal cancer? Dis Colon Rectum 41:1244–1249PubMedCrossRefGoogle Scholar
  25. 25.
    Garcia-Saenz JA, Sáenz C, Gonzalez L et al (2006) Significance of the immunohistochemical detection of lymph node micrometastases in stage II colorectal carcinoma. Clin Transl Oncol 8: 676–680PubMedCrossRefGoogle Scholar
  26. 26.
    Noura S, Yamamoto H, Ohnishi T et al (2002) Comparative detection of lymph node micrometastases of stage II colorectal cancer by reverse transcriptase polymerase chain reaction and immunohistochemistry. J Clin Oncol 20:4232–4241PubMedCrossRefGoogle Scholar
  27. 27.
    Swanson RS, Compton C, Stewart AK, Bland KI (2003) The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Oncol 10:65–71PubMedCrossRefGoogle Scholar
  28. 28.
    Le Voyer TE, Sigurdson ER, Hanlon AL et al (2003) Colon rectal survival is associated with increasing number of number of lymph nodes analysed: a secondary survey of Intergroup Trial INT-0089. J Clin Oncol 21:2912–2919PubMedCrossRefGoogle Scholar

Copyright information

© Feseo 2008

Authors and Affiliations

  • Carlos E. Bosch Roig
    • 1
    Email author
  • Ester Roselló-Sastre
    • 2
  • Sonia Alonso Hernández
    • 2
  • Daniel Almenar Cubells
    • 1
  • Enrique Grau Cardona
    • 3
  • Natalia Camarasa Lillo
    • 2
  • Daniel Bautista
    • 4
  • Carmen Molins Palau
    • 1
  1. 1.Medical Oncology UnitDr. Peset University HospitalValenciaSpain
  2. 2.Service of PathologyDr. Peset University HospitalValenciaSpain
  3. 3.General and Digestive Surgery ServiceDr. Peset University HospitalValenciaSpain
  4. 4.Preventive Medicine UnitDr. Peset University HospitalValenciaSpain

Personalised recommendations