Skip to main content
Log in

Sentinel lymph node biopsy as a prognostic factor in non-metastatic colon cancer: a prospective study

  • Research Article
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript



Around a third of node-negative patients with colon cancer experience a recurrence after surgery, suggesting poor staging. Sentinel lymph node techniques combined with immunochemistry could improve colon cancer staging. We prospectively assessed the effect of Sentinel node mapping on staging and survival in patients with non-metastatic colon cancer.


An observational and prospective study was designed. 105 patients with colon cancer were selected. Patients were classified according to node involvement as: N1, with node invasion detected by the conventional techniques; up-staged, with node invasion detected only by sentinel node mapping; and N0, with negative lymph node involvement by both techniques. Five-year survival and disease-free survival rates were analysed. Multivariate regression analyses were performed to identify prognostic factors for disease-free and overall survival.


Sentinel node mapping was successfully applied in 78 patients: 33 % were N1; 24.5 % were up-staged (18 patients with isolated tumour cells and 1 patient with micrometastases); and 42.5 % were N0. N1 patients had the poorest overall 5-year survival (65.4 %) and 5-year disease-free survival (69.2 %) rates compared with the other two groups. No significant 5-year survival differences were observed between N0 patients (87.9 %) and up-staged patients (84.2 %).


Patients up-staged after sentinel node mapping do not have a poorer prognosis than patients without node involvement. Detection of isolated cancer cells was not a poor prognosis factor in these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others


  1. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase. No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer. 2013. http://globocan.iarc.f.

  2. Robertson JM. Early diagnosis and treatment of cancer: colorectal cancer. Int J Radiat Oncol Biol Phys Elsevier Inc. 2011. doi:10.1016/B978-1-4160-4686-8.50006-3.

    Google Scholar 

  3. Figueredo A, Coombes ME, Mukherjee S. Cochrane database of systematic reviews. The Cochrane database of systematic reviews. Chichester: Wiley. 1996 [cited 2015 Apr 15]. CD005390. Available from:

  4. André T, Sargent D, Tabernero J, O’Connell M, Buyse M, Sobrero A, et al. Current issues in adjuvant treatment of stage ii colon cancer. Ann Surg Oncol 13(6):887–98. Available from: [cited 2015 Apr 15].

  5. Washington MK, Berlin J, Branton P, Burgart LJ, Carter DK, Fitzgibbons PL, et al. Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum. Arch Pathol Lab Med. 2009;133:1539–51.

    PubMed  PubMed Central  Google Scholar 

  6. Resch A, Langner C. Lymph node staging in colorectal cancer: old controversies and recent advances. World J Gastroenterol. 2013;19(46):8515–26.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mescoli C, Albertoni L, Pucciarelli S, Giacomelli L, Russo VM, Fassan M, et al. Isolated tumor cells in regional lymph nodes as relapse predictors in stage I and II colorectal cancer. J Clin Oncol. 2012;30(9):965–71.

    Article  PubMed  Google Scholar 

  8. Finan KR, Lewis JS, Winslow E, Mutch MG, Birnbaum EH, Fleshman JW. Ex vivo sentinel lymph node mapping in patients undergoing proctectomy for rectal cancer. Dis Colon Rectum. 2010;53:243–50.

    Article  PubMed  Google Scholar 

  9. Gould EA, Winship T, Philbin PHKH. Observations on a “sentinel node” in cancer of the parotid. Cancer. 1960;13:77–8.

    Article  CAS  PubMed  Google Scholar 

  10. Cabanas RM. An approach for the treatment of penile carcinoma. Cancer. 1977;39(2):456–66.

    Article  CAS  PubMed  Google Scholar 

  11. Krag D, Weaver D, Ashikaga T, Moffat F, Klimberg VS, Shriver C, et al. The sentinel node in breast cancer—a multicenter validation study. N Engl J Med. 1998;339(14):941–6.

    Article  CAS  PubMed  Google Scholar 

  12. Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Nieweg OE, Roses DF, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014;370(7):599–609. Available from:

  13. Tanis PJ, Nieweg OE, Valdés Olmos RA, Th Rutgers EJ, Kroon BB, Nieweg OE. History of sentinel node and validation of the technique. Breast Cancer Res. 2001;3:109–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Scabini S. Sentinel node biopsy in colorectal cancer: must we believe it? World J Gastrointest Surg. 2010;2(1):6–8.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Broderick-Villa G1, Ko A, O’Connell TX, Guenther JM, Danial T DL. Does tumor burden limit the accuracy of lymphatic mapping and sentinel lymph node biopsy in colorectal cancer? Cancer J. 2002;8(6):445–50.

  16. Sommariva A, Donisi PM, Gnocato B, Vianello R, Stracca Pansa V, Zaninotto G. Factors affecting false-negative rates on ex vivo sentinel lymph node mapping in colorectal cancer. Eur J Surg Oncol Elsevier Ltd. 2010;36(2):130–4. doi:10.1016/j.ejso.2009.06.007.

  17. Wood TF, Saha S, Morton DL, Tsioulias GJ, Rangel D Jr, et al. Validation of lymphatic mapping in colorectal cancer: in vivo, ex vivo, and laparoscopic techniques. Ann Surg Oncol. 2001;8(2):150–7.

    Article  CAS  PubMed  Google Scholar 

  18. Hermanek P, Hutter RVP, Sobin LH, Wittekind C. Classification of isolated tumor cells and micrometastasis. Cancer. 1999;86(12):2668–73.

    Article  CAS  PubMed  Google Scholar 

  19. Minsky B, Mies C. The clinical significance of vascular invasion in colorectal cancer. Dis Colon Rectum. 1989;32(9):794–803.

    Article  CAS  PubMed  Google Scholar 

  20. Moertel CG, Fleming TR, Macdonald JS, Haller DG, Laurie JA, Goodman PJ, et al. Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. N Engl J Med. 1990;322:352–8. doi:10.1056/NEJM199002083220602.

    Article  CAS  PubMed  Google Scholar 

  21. Viehl CT, Guller U, Cecini R, Langer I, Ochsner A, Terracciano L, et al. Sentinel lymph node procedure leads to upstaging of patients with resectable colon cancer: results of the swiss prospective, multicenter study sentinel lymph node procedure in colon cancer. Ann Surg Oncol. 2012;19(6):1959–65. doi:10.1245/s10434-012-2233-6.

    Article  PubMed  Google Scholar 

  22. Saha S, Johnston G, Korant A, Shaik M, Kanaan M, Johnston R. Aberrant drainage of sentinel lymph nodes in colon cancer and its impact on staging and extent of operation. Am J Surg Elsevier Inc. 2013;205(3):302–6. doi:10.1016/j.amjsurg.2012.10.029.

    Article  Google Scholar 

  23. van der Zaag ES, Bouma WH, Tanis PJ, Ubbink DT, Bemelman W a, Buskens CJ. Systematic review of sentinel lymph node mapping procedure in colorectal cancer. Ann Surg Oncol. 2012;19(11):3449–59. Available from:

  24. Saltz LB, Minsky B. Adjuvant therapy of cancers of the colon and rectum. Surg Clin North Am. 2002;82(5):1035–58.

    Article  PubMed  Google Scholar 

  25. Belt EJT, van Stijn MFM, Bril H, de Lange-de Klerk ESM, Meijer GA, Meijer S, et al. Lymph node negative colorectal cancers with isolated tumor deposits should be classified and treated as stage III. Ann Surg Oncol. 2010;17:3203–11.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Sloothaak DM, Sahami S, van der Zaag-Loonen HJ, van der Zaag ES, Tanis PJ, Bemelman WA, et al. The prognostic value of micrometastases and isolated tumour cells in histologically negative lymph nodes of patients with colorectal cancer: a systematic review and meta-analysis. Eur J Surg Oncol Elsevier Ltd. 2014;40(3):263–9. Available from:

  27. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010:1471–4. doi:10.1245/s10434-010-0985-4.

  28. Rahbari NN, Bork U, Motschall E, Thorlund K, Büchler MW, Koch M, et al. Molecular detection of tumor cells in regional lymph nodes is associated with disease recurrence and poor survival in node-negative colorectal cancer: a systematic review and meta-analysis. J Clin Oncol. 2012;30(1):60–70.

    Article  PubMed  Google Scholar 

  29. Bukholm IRK, Bondi J, Wiik P, Nesland JM, Andersen SN, Bakka A, et al. Presence of isolated tumour cells in mesenteric lymph nodes predicts poor prognosis in patients with stage II colon cancer. Eur J Surg Oncol. 2003;29(10):862–6.

    Article  CAS  PubMed  Google Scholar 

  30. Cristofanilli M. Circulating tumor cells, disease progression, and survival in metastatic breast cancer. Semin Oncol. 2006;33(suppl. 9):9–14.

    Article  Google Scholar 

  31. Cohen SJ, Punt CJA, Iannotti N, Saidman BH, Sabbath KD, Gabrail NY, et al. Prognostic significance of circulating tumor cells in patients with metastatic colorectal cancer. Ann Oncol. 2009;20(7):1223–9.

    Article  CAS  PubMed  Google Scholar 

  32. Miller MC, Doyle GV, Terstappen LWMM. Significance of circulating tumor cells detected by the cell search system in patients with metastatic breast colorectal and prostate cancer. J Oncol. 2010;2010:617421.

    Article  PubMed  Google Scholar 

Download references


The authors would like to thank Mateu Serra for their collaboration in writing the paper; and Elisabet Palomera for performing the statistical analyses for the study.

Conflict of interest

All authors expose and have no financial or personal relationships with other people or organisations that could inappropriately influence in the study.

Author information

Authors and Affiliations


Corresponding author

Correspondence to O. Estrada.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Estrada, O., Pulido, L., Admella, C. et al. Sentinel lymph node biopsy as a prognostic factor in non-metastatic colon cancer: a prospective study. Clin Transl Oncol 19, 432–439 (2017).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: