Restaging of colorectal cancer based on the identification of lymph node micrometastases through immunoperoxidase staining of CEA and cytokeratins

Abstract

The present study was performed to identify tumor cells in lymph nodes from colorectal adenocarcinomas considered free of disease by the classic hematoxylin-eosin stain, based on the detection of the carcinoembryonic antigen (CEA) and cytokeratins in neoplastic epithelial cells. For this purpose, 603 lymph nodes from 46 lesions were stained by the peroxidase-antiperoxidase technique. Tumor cells were detected in 22 nodes from 12 patients, mainly in the subcapsular sinuses, permitting a restaging of these patients into two groups: those now considered to have metastatic disease and those free of metastases. However, the 5-year follow-up showed no statistical differences in survival between the two groups.

Preoperative carcinoembryonic antigen level as an independent prognostic factor in potentially curative colon cancer

“…It may also be elevated under several malignant and benign gastrointestinal tract conditions [18]. CEA is overexpressed primarily by adenocarcinomas including colon, rectum, breast, and lung and more than 90% of primary colorectal carcinomas produce CEA [19]. In colon cancer, CEA modulates intercellular adhesion and functions as a promoter of cellular aggregation [20,21], suggesting that CEA has an important role as a facilitator of tumor invasion and metastasis.…”

Current Status of Sentinel Lymph Node Mapping and Biopsy: Facts and Controversies

“…Rosenberg et al reported a similar finding for RT-PCR specific for CEA and CK-20 [57]. These studies are certainly compelling; however, as in breast and melanoma, not all the literature supports the negative prognostic value of micrometastatic disease [58,59]. The next step is to identify these patients prospectively and determine if adjuvant chemotherapy would benefit this select group as opposed to all Dukes' B patients.…”

Significado prognóstico das micrometástases nos linfonodos do carcinoma colorretal: detecção imunoistoquímica com anticorpos anticitoqueratina AE1/AE3

“…Pode-se especular que, em indivíduos imunocompetentes, estas células isoladas não são suficientes para cons- tituir metástase e que seriam destruídas por mecanismos imunológicos 13 . Assim, é possível que a carga tumoral bioagressiva contida nas micrometástases seja de impacto baixo e o seu desenvolvimento contido pelas defesas imunológicas inespecíficas e/ou específicas do hospedeiro.…”

“…O reestadiamento a partir da detecção do envolvimento micrometastático pode não ter implicações clíni-cas objetivas, uma vez que os resultados deste estudo, a exemplo dos de outros autores 1,5,13,[18][19][20] , revelaram ausên-cia de impacto negativo da presença de micrometástases na sobrevivência dos doentes submetidos à extirpação curativa do carcinoma colorretal. Por outro lado, outros investigadores sustentaram que a identificação de micrometástases linfonodais teria influência negativa na sobrevivência dos seus portadores 3,17,21 .…”