Clinical Significance of Lymph Node Micrometastasis in Stage I and II Colon Cancer

Abstract

Purpose: A 25% rate of recurrence after performing complete resection in node-negative colon cancer patients suggests that their nodal staging is frequently suboptimal. Moreover, the value of occult cancer cells in tumor-free lymph nodes still remains uncertain. The authors evaluated the prognostic significance of the pathologic parameters, including the lymph node occult disease (micrometastases) detected by immunohistochemistry, in patients with node-negative colon cancer. Materials and Methods:The study included 160 patients with curatively resected stage I or II colon cancer and they were without rectal cancer. 2852 lymph nodes were re-examined by re-do hematoxylin and eosin (H-E) staining and immunohistochemical staining. The detection rates were compared with the clinicopathologic characteristics and with the cancer-specific survival.Results: Occult metastases were detected in 8 patients (5%). However, no clinicopathologic parameter was found to be correlated with the presence of micrometastasis. Twenty patients developed recurrence at a median follow-up of 45.7 months: 14 died of colon cancer and 9 died from noncancer-related causes. Univariate analysis showed that lymphatic invasion and the number of retrieved lymph nodes significantly influenced survival, and multivariate analysis revealed that the stage, the number of retrieved lymph nodes and lymphatic invasion were independently related to the prognosis.Conclusions: Inadequate lymph node retrieval and lymphatic invasion were found to be associated with a poorer outcome for node-negative colon cancer patients. The presence of immunostained tumors cells in pN0 lymph nodes was found to have no significant effect on survival, but these tumor were identified by re-do H-E staining.

Lymph Node Metastases in Rectal Cancer After Preoperative Radiochemotherapy

“…24 In addition, in patients with colorectal cancers undergoing primary surgery the prognostic significance of nodal micrometastases, although having been extensively investigated, remains controversial. [25][26][27][28] In our study, 11% of the patient cohort presented with exclusive micrometastatic involvement of mesorectal LNs. The 5-year DFS and CSS rates (76% and 86%, respectively) were comparable to those of node-negative patients.…”

Molecular investigation of lymph nodes in colon cancer patients using one‐step nucleic acid amplification (OSNA)

“…Indeed, the cutoff chosen for OSNA positivity (250 copies/μL) will not be reached if only isolated tumor cells are present, as clearly reflected in Table 4: Seventy-seven isolated tumor cells that were detected immunohistochemically were negative in OSNA. However, the prognostic implications of small tumor infiltrates in lymph nodes from patients with colon cancer are unknown and remain a matter of great debate 5, 23, 27-30…”

“…This phenomenon is explained in part by small lymph node tumor infiltrates, which remain undetected using current histopathologic workup 4, 5. Most commonly, only 1 level of hematoxylin and eosin (H&E) staining is performed to assess lymph nodes in patients with colon cancer.…”

Comparative Analysis between Multilevel Sectioning with Conventional Haematoxylin and Eosin Staining and Immunohistochemistry for Detecting Nodal Micrometastases with Stage I and II Colorectal Cancers

“…immunohistochemistry staining for epithelial and/or tumour-associated antigens (e.g. cytokeratin (CK), carcinoembrionic antigen (CEA), CAM 5.2) (Rosenberg et al, 2004;Park et al, 2008;Faerden et al, 2011). More sophisticated methods by molecular diagnostic techniques have been introduced in recent years to improve detection of nodal micrometastasis (Waldman et al, 2009;Haince et al, 2010;Hyslop et al, 2011).…”