Prognostic value of the detection of lymph node micrometastases in colon cancer
Prognostic value of the detection of lymph node micrometastases in colon cancer
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DOI：
10.1007/s12094-008-0252-9
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发表时间：
2008-09-01
影响因子：
3.4
通讯作者：
Molins Palau, Carmen
中科院分区：
文献类型：
--
作者：
Bosch Roig, Carlos E.;Rosello-Sastre, Ester;Molins Palau, Carmen
本文研究了IIA期和IIB期结肠腺癌患者淋巴结隐匿性转移-微转移（mm +）或分离性肿瘤细胞（ITCs+）的临床影响，初步认为其对应于N0。材料和方法回顾性研究39例IIA期和IIB期（T3-T4 N0 M0）结肠癌患者，接受类似的手术和辅助化疗，在新的组织学和免疫组织化学（细胞角蛋白）切片的帮助下，对其先前切除的淋巴结进行了长时间的仔细随访（至少5年，平均81.7个月），以检测mm或ITCs。根据相应的Kaplan-Meier生存曲线和Breslow试验，比较两组（mm +或ITCs+患者与无mm或ITCs患者）的5年无病生存期（DFS）和总体生存期（GS）。结果39例患者共382个淋巴结（平均9.8个，标准差6.09）被修正。在细胞角蛋白研究中，2例检测到mm +， 2例检测到ITCs+。全系列患者5年时的GS为89.74%（35例存活），5年时的DFS为79.49%（31例无病），但2例mm +组患者5年时死亡，两组间具有较高的统计学差异（mm +/ mm -） （p < 0.0001）。MM +/ITCs+组与MM-/ITCs-组比较，MM-/ITCs-组5年DFS和GS次数较高（p=0.0692和p=0.006）。结论：虽然mm +或ITCs+在检查淋巴结中的发生率较低，但mm的存在与5年GS和DFS的显著降低有关。我们鼓励对深穿透性结肠肿瘤患者切除的淋巴结进行详细的组织学研究，以确保pN0状态。
Introduction and objectives A study is made of the clinical repercussions of occult metastases-micrometastases (MMs+)-or isolated tumour cells (ITCs+) in the lymph nodes of patients with stage IIA and IIB colon adenocarcinoma initially considered as corresponding to N0.Material and methods A retrospective study of 39 patients with stage IIA and IIB (T3-T4 N0 M0) colon adenocarcinoma, subjected to similar surgical and adjuvant chemotherapy treatment, with long and careful follow-up (minimum: 5 years, mean: 81.7 months) was performed on their previously resected lymph nodes, with the aid of new histological and immunohistochemical (cytokeratin) sections, in order to detect MMs or ITCs. Disease-free survival (DFS) and global survival (GS) in the two groups (patients with MMs+ or ITCs+ vs. patients without MMs or ITCs) were compared at 5 years based on the corresponding Kaplan-Meier survival curves, with the Breslow test.Results A total of 382 lymph nodes from the 39 patients (mean: 9.8; standard deviation: 6.09) were revised. MMs+ were detected in 2 cases and ITCs+ in 2 more cases on the Cytokeratin study. GS of the whole series at 5 years was 89.74% (35 patients alive) with a DFS at 5 years of 79.49% (31 patients free of disease), but the 2 cases with MMs+ were dead at 5 years, with high statistical differences between both groups (MMs+/MMs-) (p < 0.0001). When comparing the group of MMs+/ITCs+ patients and the group of MM-/ITCs- patients, the DFS and GS times at 5 years were higher in the MMs-/ITCs- group (p=0.0692 and p=0.006 respectively).Conclusions Although the incidence of MMs+ or ITCs+ in the examined lymph nodes was low, the presence of MMs is related to a dramatic reduction in GS and DFS at 5 years. We encourage a detailed histological study of lymph nodes resected in patients with deep penetrating colon tumours in order to assure a pN0 status.