Presence of isolated tumour cells in mesenteric lymph nodes predicts poor prognosis in patients with stage II colon cancer

Bukholm, Ida Rashida Khan; Bondi, Johan; Wiik, Pål; Nesland, Jahn M.; Andersen, Solveig Norheim; Bakka, Arne; Bukholm, Geir

doi:10.1016/j.ejso.2003.09.007

Cited by 42 publications

(21 citation statements)

References 17 publications

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“…These results are consistent with data in the literature reporting a proportion of up-graded patients of from 7% to 31% (6,21). The prognostic value of occult metastases detected by IHC or RT-PCR in colorectal cancer remains a matter of debate (22)(23)(24). The results of an ongoing study that will address this issue are expected (25).…”

Section: Discussionsupporting

confidence: 81%

Sentinel Lymph Node Detection by Blue Dye Versus Indocyanine Green Fluorescence Imaging in Colon Cancer

Liberale

Vankerckhove

Galdón

et al. 2016

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Abstract. Background In patients with colorectal cancer (CRC), the accurate establishment of the pathological status of tumor-draining mesenteric lymph nodes (LN) is of central importance for therapeutic management. In patients with stage III disease with demonstrated LN metastases, adjuvant systemic chemotherapy is indicated, reducing the risk of recurrence and improving long-term overall survival (1). The accuracy of mesenteric nodal staging depends primarily on the number of resected LN, and the seventh American Joint Committee on Cancer (AJCC) edition recommends harvesting and analysis of at least 12 to 14 LN for correct staging (2). Despite this, 20-30% of patients with no LN metastases demonstrated at pathology (pN0), and therefore classified as stage II, still develop recurrent disease (3). These recurrences could potentially be associated with unrecognized locoregional nodal metastases, which could lead to understaging and undertreatment.The sentinel lymph node (SLN) is defined as the first LN draining the primary tumor. In melanoma and breast cancer, it has been shown that pathological status of the SLN is indicative of the risk of nodal metastases, thus providing an indication for lymphadenectomy when SLN pathological examination is positive and for avoiding mutilating surgery when it is negative (4, 5). The concept, and potential utility, of the SLN is different in CRC since mesenteric lymphadenectomy is systematically performed during surgery for the primary tumor. In patients with CRC, the particular contribution of SLN examination could be to focus the pathological analysis specifically on draining LNs in order to improve the sensitivity for cancer cell detection by the use of advanced methods, such as serial sectioning, immunohistochemistry (IHC), and molecular analyses such as reverse transcriptase polymerase chain reaction (RT-PCR) to increase pathological staging (6).Accordingly, a recent meta-analysis concluded that the use of SLN examination allowed for nodal up-staging of patients with CRC, providing a potential benefit (7). However, the technique of SLN analysis is still not widely used in patients with CRC. This could be related to the variability of the sensitivity of techniques for SLN detection which ranges from 33% to 100%, to the risk of missed metastases, and also to uncertainty related to the clinical significance and prognostic value of nodal micrometastases in CRC (7-9).Recently, fluorescence imaging (FI) using indocyanine green (ICG) has emerged as a new technique for SLN detection in various tumors (10)(11)(12). Only few studies have 4853

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Section: Discussionsupporting

confidence: 81%

Sentinel Lymph Node Detection by Blue Dye Versus Indocyanine Green Fluorescence Imaging in Colon Cancer

Liberale

Vankerckhove

Galdón

et al. 2016

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“…By using immunohistochemical staining for cytokeratins to detect occult lymph node invasion, it was shown that the presence of isolated tumor cells in mesenteric lymph nodes was an independent predictor of reduced relative survival in patients with stage II colon cancer. 41 However, many retrospective studies concerning lymphatic mapping have reported contrary findings. 47 The laboriousness and high cost of reliably screening a large number of lymph nodes for occult metastases has led to the concept of sentinel lymph node mapping.…”

Section: Assessment Of the Number Of Lymph Nodesmentioning

confidence: 91%

“…have been disseminated at the time of tumor resection. 41 The American Joint Committee on Cancer and the tumor-node-metastasis committee of the International Union Against Cancer and the Working Party Report to the World Congresses of Gastroenterology issued the consensus recommendation that at least 12 nodes should be sampled to stage a patient adequately. 42 Several recent studies have suggested that the number of nodes examined should be between 8 and 20.…”

Section: Assessment Of the Number Of Lymph Nodesmentioning

confidence: 99%

Current Issues in Adjuvant Treatment of Stage II Colon Cancer

et al. 2006

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Background: Adjuvant chemotherapy with 5-fluorouracil modulated by folinic acid, combined with oxaliplatin, has now become an accepted standard of care for patients with stage III colon cancer. In contrast, the use of adjuvant therapy for stage II patients remains controversial, and the identification of reliable prognostic factors to aid therapeutic decision making is crucial.Methods: The authors critically review the results of clinical trials and meta-analyses investigating the value of adjuvant chemotherapy for stage II patients, emphasizing the heterogeneous nature of this population and the difficulty of performing clinical trials with sufficient power to reliably assess treatment efficacy. They also discuss the evidence concerning potential prognostic factors, particularly molecular markers.Results: Available clinical trial data do not support the routine use of adjuvant chemotherapy for all stage II patients but suggest that it should be considered, particularly for certain high-risk patients. Recent guidelines advocate considering factors such as tumor differentiation, tumor perforation, number of lymph nodes examined, and T stage when assessing the likely benefit:risk ratio. Microsatellite instability and allelic imbalance seem to be strong predictors of good and poor prognosis, respectively, and in the near future, therapeutic decisionmaking models are likely to be further refined by the inclusion of such molecular markers.Conclusions: There is growing evidence that the prognosis of certain stage II patients with unfavorable prognostic factors can be improved by adjuvant chemotherapy, and increasingly refined tools are now available to define those most likely to benefit. Referral of stage II patients for individual assessment is strongly recommended.

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“…[19][20][21][23][24][25][26] Nonetheless, the prognostic significance of IHC-and/ or RT-PCR-detected micrometastases remains unclear (Table 4). 8,[59][60][61][62][63][64][65][66][67][68][69] Only 3 of the 12 reported studies found that the presence of nodal micrometastases correlates with a significantly worse survival. 62,63,65 Three studies reported that the detection of micrometastases is related to a higher risk for recurrent disease.…”

Section: Figmentioning

confidence: 99%

“…8,[59][60][61][62][63][64][65][66][67][68][69] Only 3 of the 12 reported studies found that the presence of nodal micrometastases correlates with a significantly worse survival. 62,63,65 Three studies reported that the detection of micrometastases is related to a higher risk for recurrent disease. 61,62,69 These diverging results are partially explained by a lack of uniform techniques, different study designs and patient populations, different numbers of lymph nodes evaluated, and paucity of prospective data (Table 4).…”

Section: Figmentioning

confidence: 99%

Sentinel Lymph Node Mapping in Colon Cancer: Current Status

et al. 2007

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Background: The primary role of sentinel lymph node (SLN) mapping in colon cancer is to increase the accuracy of nodal staging by identifying those lymph nodes with the greatest potential for harbouring metastatic disease. Ultrastaging techniques aim to identify the otherwise undetected metastases. Until now, no consensus exists as to the most optimal procedure in patients with colon cancer.Methods: A systematic literature search on the value of different SLN mapping techniques in patients with colon cancer was performed using the electronic search engine PubMed. Prospective studies published before 1 December 2005 were included and further articles were selected by cross-referencing. The results of different techniques using either blue dye or radiocolloid, were investigated.Results: The literature search yielded 17 relevant articles. SLN mapping using blue dye was described in 15 studies. Two studies reported the results of SLN mapping using a combination of blue dye and radiocolloid. The reported results on identification rate varied between 71 and 100%. Accuracy rates were between 78 and 100%, sensitivity rates between 25 and 100% and true upstaging rates between 0 and 26%. The results were not affected by the addition of radiocolloid to blue dye.Conclusions: Sentinel lymph node mapping in patients with colon cancer remains an experimental procedure with varying results. Further evaluation may lead to a standardized technique that offers the potential for significant upstaging of stage II patients. This may have important implications as to tailor adjuvant chemotherapeutic regimens in these patients.

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Presence of isolated tumour cells in mesenteric lymph nodes predicts poor prognosis in patients with stage II colon cancer

Cited by 42 publications

References 17 publications

Sentinel Lymph Node Detection by Blue Dye Versus Indocyanine Green Fluorescence Imaging in Colon Cancer

Sentinel Lymph Node Detection by Blue Dye Versus Indocyanine Green Fluorescence Imaging in Colon Cancer

Current Issues in Adjuvant Treatment of Stage II Colon Cancer

Sentinel Lymph Node Mapping in Colon Cancer: Current Status

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