Volume of Lymphatic Metastases Does Not Independently Influence Prognosis in Colorectal Cancer

Abstract

The number of nodes involved with metastatic tumor, rather the volume of metastatic involvement of the regional lymph nodes, predicts outcome. These results suggest that micrometastatic disease may have a similar prognosis as macrometastatic disease when the same number of lymph nodes are involved with metastatic tumor.

Pathological assessment of pericolonic tumor deposits in advanced colonic carcinoma: relevance to prognosis and tumor staging

“…2 Missing additional features, however, may account for remarkable prognostic differences between patients in the same risk category. In this regard, the volume of metastatic lymph node involvement is not an independent prognostic indicator in colorectal cancer, 5 and the role of extracapsular tumor spreading still awaits further confirmation. 6 As far as vascular invasion is concerned, it is still unclear whether different types of vascular invasion (lymphatic or venous) are prognostically relevant as independent factors 10 or whether vascular invasion per se may have clinical implications on tumor staging.…”

“…4 Whether additional qualitative features, currently not mentioned in the TNM UICC classification, may be relevant to nodal stage has already been addressed, and a few studies have investigated the prognostic role of the volume of metastatic lymph node involvement and of extracapsular tumor spreading. 5,6 Vascular, lymphatic and perineural invasion have been shown to correlate with a poor prognosis 7,8 but without directly affecting tumor staging. 9,10 Besides stage III substaging, another change in the latest TNM classification was the reappraisal of pericolonic tumor deposits, which are metastatic adenocarcinoma nodules occurring in the pericolonic and perirectal fat, often in close association with blood vessels.…”

Lymph node harvest in colon cancer specimens depends on tumour factors, patients and doctors, but foremost on specimen handling

“…It is well known that colon cancer has a poorer prognosis when it has metastasized to local lymph nodes (3, 12, 13). Consequently, it is an accepted principle that all tissue containing lymph node metastases should be removed in an effort to improve outcome (4).…”

“…At least one study (27) did not report the number of lymph nodes harvested. From a pathologist’s perspective, only a couple of studies focused on the total number of lymph nodes in colon cancer specimens (10, 12).…”

High prevalence of isolated tumour cells in regional lymph nodes from pN0 colorectal cancer

“…36 Take-home messages N Presence of ITC in regional lymph nodes might help to explain pN0 early-relapsing CRCs. N Further studies are required to prospectively evaluate the clinico-biological relevance and the prognostic significance of ITC.…”