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Positive lymph nodes do not metastasize

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Abstract

Our understanding of the role of lymph nodes (LN) in the metastasization process (MET) is marginal. Positive LNs (pLN) are the most important prognostic factor and lymph node dissection (LND) is still standard practice in primary treatment. However, up to now, there is almost no evidence that elective LND has a survival benefit. Based on many clinical and experimental findings, we propose that tumor foci in regional LN are incapable of metastasization and can therefore not infiltrate further LN and organs. Available data demonstrate a very early infiltration of MET capable tumor cells from the primary tumor into regional LN, and thereafter an increased probability of subsequent LN infiltrations. Disparate growth rates of the first versus subsequent infiltrating tumors as well as the asymptotic growth and prognosis of large tumor foci in LN explain many clinical observations for solid tumors. The consequence of the hypothesis “pLN do not metastasize” would impact clinical treatment and research and contribute to understanding the mounting evidence against LND.

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Abbreviations

BC:

Breast cancer

LN:

Lymph node(s)

pLN:

Positive lymph node(s)

LND:

Lymph node dissection

SLN:

Sentinel lymph node

MET:

(distant) metastasization

PT:

Primary tumor

TC(D):

Tumor cell (dissemination)

VD(T):

Volume doubling (time)

pNITC :

Isolated TC in LN <0.2 mm

pNmicro :

Micrometastasis in LN (0.2–2 mm)

pN:

Pathological classification of regional lymph node

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Acknowledgments

We thank the many doctors and clinicians who cooperate within the complex network of the Munich Cancer Registry (MCR), despite the back-breaking medical bureaucracy required for daily health care. Especially, we thank our co-workers in the MCR who handle hundreds of thousands of findings and treatment reports and compile them into valid courses of disease. We are also indebted to I Bauerfeind, HP Bruch, J Haier, R Holland, M Hölzel, CA Klein, U Löhrs, D Meyer, K Pantel, G Riethmüller, H-J Sauer, U Schumacher, J. Werner, and F Winkler for insightful information and discussions, especially concerning contrary positions, because dissent rather than consensus is a prime motivation for innovations.

Conflicts of interest

We declare that we have no conflicts of interest.

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Authors and Affiliations

  1. Munich Cancer Registry (MCR) of the Munich Cancer Centre (MCC) at the Institute for Medical Informatics, Biometry and Epidemiology IBE, Ludwig-Maximilians-University, Clinic Großhadern, Munich, Germany

    Jutta Engel, Rebecca T. Emeny & Dieter Hölzel

  2. Tumorregister München, Klinikum Grosshadern, 81377, Munich, Germany

    Dieter Hölzel

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  1. Jutta Engel
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  2. Rebecca T. Emeny
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  3. Dieter Hölzel
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Correspondence to Dieter Hölzel.

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Engel, J., Emeny, R.T. & Hölzel, D. Positive lymph nodes do not metastasize. Cancer Metastasis Rev 31, 235–246 (2012). https://doi.org/10.1007/s10555-011-9343-7

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  • DOI: https://doi.org/10.1007/s10555-011-9343-7

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