Lymph Node Negative Colorectal Cancers with Isolated Tumor Deposits Should Be Classified and Treated As Stage III

Belt, Eric; Stijn, Mireille F. M. van; Bril, Herman; Klerk, Elly S.M. de Lange–de; Meijer, Gerrit A.; Meijer, S.; Stockmann, H. B. A. C.

doi:10.1245/s10434-010-1152-7

Cited by 84 publications

(83 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, Fig. 3b suggests that even pN micro and pN ITC are risk factors, even if only the sentinel LN (SLN) is involved [8,26,[47][48][49][50][51]. Therefore, a macroscopic pN0 cohort in Fig.…”

Section: Pln Do Not Initiate Distant Metmentioning

confidence: 97%

Positive lymph nodes do not metastasize

Engel¹,

Emeny²,

Hölzel

2011

Cancer Metastasis Rev

View full text Add to dashboard Cite

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.

show abstract

Section: Pln Do Not Initiate Distant Metmentioning

confidence: 97%

Positive lymph nodes do not metastasize

Engel¹,

Emeny²,

Hölzel

2011

Cancer Metastasis Rev

View full text Add to dashboard Cite

show abstract

“…Also in colorectal cancer, pericolic and perirectal isolated tumor deposits are found. But their prognostic role is controversially discussed which is in part indicated by the change of the definition in the last three TNM editions [61,75].…”

Section: Effect Of Radiotherapy On Ibtrmentioning

confidence: 99%

“…E.g., in colorectal cancer isolated tumor deposits are rare for pT1-2 tumors but common for pT3-4 [75]. That is, a tumor cell migration independent of blood or lymphatic vessels from submucosa or muscularis propria is probably not possible.…”

Section: Effect Of Radiotherapy On Ibtrmentioning

confidence: 99%

True local recurrences do not metastasize

Hölzel

Emeny

Engel

2011

Cancer Metastasis Rev

View full text Add to dashboard Cite

Generally, the limits of local tumor control are in part connected with the term "field cancerization" and are known from oral, lung, prostate, or mammary cancer. With the example of breast cancer (BC), the problem of ipsilateral breast tumor recurrences (IBTR) after breast-conserving surgery will be reviewed. Three types of local recurrences are distinguished: true recurrences, new primaries, or residual tumors. Good data for BC allow the description of the time-dependent risk of these three types, relative to the diagnosis of the primary tumor, because the time of initiation and the growth duration of the IBTR can be estimated. Two hypotheses explain the data: first, local recurrences may be initiated years before the diagnosis of a primary tumor (PT) and can then appear as multifocal PT at diagnosis, and second, true local recurrences probably do not metastasize. The generalizability of these hypotheses for other tumors will be discussed.

show abstract

“…Although the majority of patients with node-negative rectal cancer are potentially curable by surgery alone, 20-30% of the patients succumb to local recurrence or distant metastasis (8)(9)(10). This occurrence may be explained by the dissemination of tumors into the lymphatic system, which cannot be detected by routine pathology.…”

Section: Discussionmentioning

confidence: 99%

“…Identification of these foci may aid the subdivision of node-negative patients for subsequent treatment to prevent relapse (10). Moreover, although the SLN of colorectal cancer has been discussed in several respects by existing studies, examination of the incidence and prognosis of occult cancer foci is still lacking from the literature.…”

Section: Introductionmentioning

confidence: 99%

Occult tumor metastasis and the prognostic value of sentinel lymph nodes in rectal cancer

et al. 2011

View full text Add to dashboard Cite

Abstract. The aim of the present study to evaluate the application of sentinel lymph node (SLN) pathology in rectal cancer using ex vivo mapping and to investigate the incidence and prognostic value of occult SLN metastasis in routine node-negative specimens. Specimens (n=117) of rectal cancer were examined using a combination of routine pathology and ex vivo SLN mapping. The inspected SLNs were further treated with immunohistochemical staining for occult cancer foci. The log-rank test was used to assess survival. SLNs were examined in 112 of the included specimens with a total number of 212, resulting in an identification rate of 95.7% (112/117). The status of SLNs accurately reflected N stage in 93.8% (105/112) of cases and the sensitivity was 75.6% (31/41) in detecting nodal metastasis. The accuracy of SLN pathology decreased in cancers of more advanced TNM stages (P=0.001). In 74 cases with routine node-negative (N0) disease, SLN micrometastasis (MIC) and isolated tumor cells (ITC) were examined in 9 and 4 cases, while the remaining 61 were regarded as negative (NEG). The log-rank test revealed poorer disease-free and overall survival of the MIC group compared with the NEG group. However, the findings from the ITC group were not significant compared with those from the MIC and NEG groups. In conclusion, ex vivo SLN pathology is practical and accurate in rectal cancer; however, its utility is limited in cases of advanced disease. Immunohistochemically detected SLN micrometastasis in node-negative cases is therefore a predictor of poorer outcome, and may therefore be listed as a marker for adjuvant therapy. IntroductionSurgery remains the first choice of treatment for patients with rectal cancer and prognosis mainly depends on the stage of disease at the time of surgery (1). At present, the most valuable staging and prognostic indicator is lymph node status, i.e., whether the lymph nodes are involved in cancer or not (2,3). Therefore, it is widely accepted that examination of a sufficient number of lymph nodes is essential for accurate staging, thus aiding prescription for adjuvant therapy (4,5).However, examination of the sentinel lymph node (SLN), defined as the node with the highest incidence of metastasis, was reported as being capable of reducing the pathological workload while maintaining diagnostic accuracy. If the results of SLN examination in breast cancer and melanoma could be duplicated in rectal cancer the effort and cost of harvesting an adequate number of nodes would no longer be necessary (6,7). The present study therefore aimed to evaluate the application of SLN pathology in rectal cancer by mapping with patent blue V dye.In addition, recurrence has been observed in those patients presenting with primarily node-negative disease, indicating that routine pathological examination may fail to detect certain occult tumor metastases (8,9). Identification of these foci may aid the subdivision of node-negative patients for subsequent treatment to prevent relapse (10). Moreover, although the SLN of colo...

show abstract

Lymph Node Negative Colorectal Cancers with Isolated Tumor Deposits Should Be Classified and Treated As Stage III

Cited by 84 publications

References 15 publications

Positive lymph nodes do not metastasize

Positive lymph nodes do not metastasize

True local recurrences do not metastasize

Occult tumor metastasis and the prognostic value of sentinel lymph nodes in rectal cancer

Contact Info

Product

Resources

About