Prospective study on the recurrence/metastasis of stage II/III colorectal cancer and gastric cancer associated with occult neoplastic cells in lymph node sinuses: Three-year interim results

Abstract

This study was designed to prospectively examine whether the presence of occult neoplastic cells (ONCs) in lymph nodes or positive high-risk (HR) criteria were related to the survival of patients with stage II/III colorectal cancer or gastric cancer. The 3-year relapse-free survival (3Y-RFS) rate was calculated for 79 patients who were registered during a 2-year period. The 3Y-RFS rate was 80.5% in patients without ONCs (n=54) and 84.3% in patients with ONCs (n=25; p=0.9089). Among patients who had stage II/III colorectal cancer, it was 89.0% (n=47) and 76.2% (n=15), respectively (p=0.4131). For patients with stage III colorectal cancer alone, it was 80.8% (n=24) and 62.5% (n=9), respectively (p=0.4006). The 3Y-RFS rate was respectively 88.1% and 77.6% for the HR patients (n=31) and low-risk (LR) patients (n=48) with stage II/III colorectal cancer or gastric cancer (p=0.5545). It was respectively 92.3% and 84.3% for the HR patients (n=20) and LR patients (n=42) with stage II/III colorectal cancer (p=0.5073). Also, the rate was respectively 80% and 76.2% for the HR patients (n=7) and LR patients (n=26) with stage III colorectal cancer alone (p=0.9506). These results indicate that the 3Y-RFS rate is lower in ONC-positive patients with stage II/III colorectal cancer, suggesting that ONCs may have an influence on survival.

Pelvic recurrence after Miles' operation for anastomotic recurrence in a patient with stage I rectal cancer invading the proper muscle layer: Case report

“…Various studies have shown that the detection of intranodal ONCs in LNs indicates the systemic spread of cancer cells more accurately than the ly and v status of the primary tumor (10)(11)(12)(13)(14)(15)(16). In fact, many clusters of extranodal ONCs were observed in the dissected perinodal fat of the present patient, despite the tumor being ly0 and v0.…”

“…Possible risk factors for the postoperative local recurrence of low rectal cancer including stage I disease are: i) an inadequate resection margin of <2 cm, ii) seeding of tumor cells by large bowel perforation due to operative manipulation or inadequate suturing, iii) implantation of viable tumor cells in the alimentary tract by mechanical anastomosis, and iv) occult microscopic tumor invasion, including visually undetectable microscopic lymph node metastasis and microscopic deposits in the pelvic fat (7)(8)(9). Many studies have also shown a close relationship between the detection of cytokeratin-positive occult neoplastic cells (ONCs) in lymph node sinuses (intranodal ONCs) far from the primary tumor and distant metastasis/recurrence of n0 disease (10)(11)(12)(13)(14)(15)(16).…”

Sensitivity to CPT-11 and platinum derivatives of stage II/Dukes' B colorectal cancer with occult neoplastic cells in lymph node sinuses

“…Solitary free ONCs in LN sinuses distant from the primary tumor can be detected by cytokeratin immunostaining, but ONCs are also defined as including clusters of ≤10 cells, while malignant microaggregates contain >10 cells (10). ONC clusters have the potential to cause tumor metastasis/ recurrence in any organ, and should be differentiated from micrometastases (0.2-2 mm) anchored in LNs or from ITCs (≤0.2 mm), since ONC clusters seem to be have a higher malignant potential (10)(11)(12).…”

Sensitivity to CPT-11 and platinum derivatives of stage II/III node-positive gastric cancer with occult neoplastic cells in lymph node sinuses

“…ONCs are also defined as including small clusters of ≤10 cells, while malignant micro-aggregates contain >10 cells 2,3,10) . ONC clusters can theoretically cause recurrence/metastasis in any organ, and should be differentiated from micrometastases (0.2 mm to 2 mm in diameter) anchored in LNs or from ITCs, since ONCs seem to be occult systemic metastases with a higher malignant potential [10][11][12] .…”