Sentinel lymph node biopsy in colon cancer -: A prospective multicerlter trial
Sentinel lymph node biopsy in colon cancer -: A prospective multicerlter trial
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DOI：
10.1097/01.sla.0000250428.46656.7e
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发表时间：
2007-06-01
影响因子：
9
通讯作者：
Schlag, Peter M.
中科院分区：
文献类型：
--
作者：
Bembenek, Andreas E.;Rosenberg, Robert;Schlag, Peter M.
简介：前哨淋巴结活检（SLNB）对结肠癌的临床影响仍存在争议。这项前瞻性多中心试验的目的是评估其预测淋巴结状态的临床价值并确定影响这些结果的因素。方法：既往未接受过结直肠手术或放射治疗的结肠癌患者符合资格。术中通过在肿瘤周围注射蓝色染料来识别前哨淋巴结（SLN）。如果在常规苏木精和伊红检查后分类为无转移，则对 SLN 进行阶梯切片和免疫组织化学 (IHC)。 结果：在 315 名入组患者中，有 268 名患者中至少鉴定出 1 个 SLN（中位数，n = 2）（检出率，85%）。中心经验、淋巴血管侵犯、体重指数（BMI）和学习曲线与检出率呈正相关。通过 SLNB 识别 pN+ 患者的假阴性率为 46%（82 例中的 38 例）。 BMI与假阴性率显着相关（P<0.0001），肿瘤累及淋巴结的数量呈负相关。如果仅在经验丰富的中心（> 22 名患者入组）中对苗条患者（BMI：24）进行调查，则敏感性增加至 88%（16 名中的 14 名）。此外，21%（141 名患者中的 30 名）通过常规组织病理学分类为 pN0，在 SLN 中发现微转移或孤立的肿瘤细胞 (MMATC)。 结论：SLNB 对结肠癌患者传统淋巴结分期的贡献仍不清楚。必须解决技术问题才能得出明确的结论。然而，SLNB 识别出大约四分之一的 II 期患者，以显示淋巴结中的 MM/ITC。进一步的研究必须阐明这些发现在预后和辅助治疗指征方面的临床影响。
Introduction: The clinical impact of sentinel lymph node biopsy (SLNB) in colon cancer is still controversial. The purpose of this prospective multicenter trial was to evaluate its clinical value to predict the nodal status and identify factors that influence these results.Methods: Colon cancer patients without prior colorectal surgery or irradiation were eligible. The sentinel lymph node (SLN) was identified intraoperatively by subserosal blue dye injection around the tumor. The SLN underwent step sections and immunohistochemistry (IHC), if classified free of metastases after routine hematoxylin and eosin examination.Results: At least one SLN (median, n = 2) was identified in 268 of 315 enrolled patients (detection rate, 85%). Center experience, lymphovascular invasion, body mass index (BMI), and learning curve were positively associated with the detection rate. The false-negative rate to identify pN+ patients by SLNB was 46% (38 of 82). BMI showed a significant association to the false-negative rate (P < 0.0001), the number of tumor-involved lymph nodes was inversely associated. If only slim patients (BMI : 24) were investigated in experienced centers (> 22 patients enrolled), the sensitivity increased to 88% (14 of 16). Moreover, 21% (30 of 141) of the patients, classified as pN0 by routine histopathology, revealed micrometastases or isolated tumor cells (MMATC) in the SLN.Conclusions: The contribution of SLNB to conventional nodal staging of colon cancer patients is still unspecified. Technical problems have to be resolved before a definite conclusion can be drawn in this regard. However, SLNB identifies about one fourth of stage II patients to reveal MM/ITC in lymph nodes. Further studies must clarify the clinical impact of these findings in terms of prognosis and the indication of adjuvant therapy.