Ex vivo localization and immunohistochemical detection of sentinel lymph node micrometastasis in patients with colorectal cancer can upgrade tumor staging

被引:7
作者
Wang, Fu-Long [1 ]
Shen, Fang [1 ]
Wan, De-Sen [1 ]
Lu, Zhen-Hai [1 ]
Li, Li-Ren [1 ]
Chen, Gong [1 ]
Wu, Xiao-Jun [1 ]
Ding, Pei-Rong [1 ]
Kong, Ling-Heng [1 ]
Pan, Zhi-Zhong [1 ]
机构
[1] Sun Yat Sen Univ, Dept Colorectal Surg, Ctr Canc, State Key Lab Oncol S China, Guangzhou 510060, Guangdong, Peoples R China
关键词
Colorectal carcinoma; Sentinel lymph node; Micrometastasis; Prognosis; COLON-CANCER; BREAST-CANCER; PROGNOSTIC VALUE; BIOPSY; METASTASIS; CARCINOMA; SURVIVAL;
D O I
10.1186/1746-1596-7-71
中图分类号
R36 [病理学];
学科分类号
100104 ;
摘要
Background: It is not clear if sentinel lymph node (SLN) mapping can improve outcomes in patients with colorectal cancers. The purpose of this study was to determine the prognostic values of ex vivo sentinel lymph node (SLN) mapping and immunohistochemical (IHC) detection of SLN micrometastasis in colorectal cancers. Methods: Colorectal cancer specimens were obtained during radical resections and the SLN was identified by injecting a 1% isosulfan blue solution submucosally and circumferentially around the tumor within 30 min after surgery. The first node to stain blue was defined as the SLN. SLNs negative by hematoxylin and eosin (HE) staining were further examined for micrometastasis using cytokeratin IHC. Results: A total of 54 patients between 25 and 82 years of age were enrolled, including 32 males and 22 females. More than 70% of patients were T3 or above, about 86% of patients were stage II or III, and approximately 90% of patients had lesions grade II or above. Sentinel lymph nodes were detected in all 54 patients. There were 32 patients in whom no lymph node micrometastasis were detected by HE staining and 22 patients with positive lymph nodes micrometastasis detected by HE staining in non-SLNs. In contrast only 7 SLNs stained positive with HE. Using HE examination as the standard, the sensitivity, non-detection rate, and accuracy rate of SLN micrometastasis detection were 31.8% (7/22), 68.2% (15/22), and 72.2%, respectively. Micrometastasis were identified by ICH in 4 of the 32 patients with HE-negative stained lymph nodes, resulting in an upstaging rate 12.5% (4/32). The 4 patients who were upstaged consisted of 2 stage I patients and 2 stage II patients who were upstaged to stage III. Those without lymph node metastasis by HE staining who were upstaged by IHC detection of micrometastasis had a significantly poorer disease-free survival (p = 0.001) and overall survival (p = 0.004). Conclusion: Ex vivo localization and immunohistochemical detection of sentinel lymph node micrometastasis in patients with colorectal cancer can upgrade tumor staging, and may become a factor affecting prognosis and guiding treatment.
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页数:8
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共 31 条
[1]   Lymph node evaluation in colorectal cancer patients: A population-based study [J].
Baxter, NN ;
Virnig, DJ ;
Rothenberger, DA ;
Morris, AM ;
Jessurun, J ;
Virnig, BA .
JOURNAL OF THE NATIONAL CANCER INSTITUTE, 2005, 97 (03) :219-225
[2]   Technique and clinical consequences of sentinel lymph node biopsy in colorectal cancer [J].
Bembenek, Andreas ;
String, Andreas ;
Gretschel, Stephan ;
Schlag, Peter M. .
SURGICAL ONCOLOGY-OXFORD, 2008, 17 (03) :183-193
[3]   Sentinel lymph node biopsy in colon cancer -: A prospective multicerlter trial [J].
Bembenek, Andreas E. ;
Rosenberg, Robert ;
Wagler, Elke ;
Gretschel, Stephan ;
Sendler, Andreas ;
Siewert, Joerg-Ruediger ;
Naehrig, Joerg ;
Witzigmann, Helmut ;
Hauss, Johann ;
Knorr, Christian ;
Dimmler, Arno ;
Groene, Joern ;
Buhr, Heinz-Johannes ;
Haier, Joerg ;
Herbst, Hermann ;
Tepel, Juergen ;
Siphos, Bence ;
Kleespies, Axel ;
Koenigsrainer, Alfred ;
Stoecklein, Nikolas H. ;
Horstmann, Olaf ;
Gruetzmann, Robert ;
Imdahl, Andreas ;
Svoboda, Daniel ;
Wittekind, Christian ;
Schneider, Wolfgang ;
Wernecke, Klaus-Dieter ;
Schlag, Peter M. .
ANNALS OF SURGERY, 2007, 245 (06) :858-863
[4]   Prognostic value of sentinel lymph node biopsy in the pathologic staging of colorectal cancer patients [J].
Bertoglio, S ;
Sandrucci, S ;
Percivale, P ;
Goss, M ;
Gipponi, M ;
Moresco, L ;
Mussa, B ;
Mussa, A .
JOURNAL OF SURGICAL ONCOLOGY, 2004, 85 (03) :166-170
[5]   Prognostic impact of micrometastases in colon cancer - Interim results of a prospective multicenter trial [J].
Bilchik, Anton J. ;
Hoon, Dave S. B. ;
Saha, Sukamal ;
Turner, Roderick R. ;
Wiese, David ;
DiNome, Maggie ;
Koyanagi, Kazuo ;
McCarter, Martin ;
Shen, Perry ;
Iddings, Douglas ;
Chen, Steven L. ;
Gonzalez, Maria ;
Elashoff, David ;
Morton, Donald L. .
ANNALS OF SURGERY, 2007, 246 (04) :568-577
[6]   Targeted Lymph Node Evaluation in Colorectal Cancer: A Decade Of Progress! [J].
Bilchik, Anton J. ;
Stojadinovic, Alexander ;
Wainberg, Zev ;
Hecht, J. Randolph .
JOURNAL OF SURGICAL ONCOLOGY, 2009, 99 (05) :273-274
[7]   Lymph node evaluation as a colon cancer quality measure: A national hospital report card [J].
Bilimoria, Karl Y. ;
Bentrem, David J. ;
Stewart, Andrew K. ;
Talamonti, Mark S. ;
Winchester, David P. ;
Russell, Thomas R. ;
Ko, Clifford Y. .
JOURNAL OF THE NATIONAL CANCER INSTITUTE, 2008, 100 (18) :1310-1317
[8]   Prognostic value of the detection of lymph node micrometastases in colon cancer [J].
Bosch Roig, Carlos E. ;
Rosello-Sastre, Ester ;
Alonso Hernandez, Sonia ;
Almenar Cubells, Daniel ;
Grau Cardona, Enrique ;
Camarasa Lillo, Natalia ;
Bautista, Daniel ;
Molins Palau, Carmen .
CLINICAL & TRANSLATIONAL ONCOLOGY, 2008, 10 (09) :572-578
[9]   Nuclear beta-catenin overexpression in metastatic sentinel lymph node is associated with synchronous liver metastasis in colorectal cancer [J].
Cheng, Hongxia ;
Liang, Hui ;
Qin, Yejun ;
Liu, Ying .
DIAGNOSTIC PATHOLOGY, 2011, 6
[10]   Colorectal cancer [J].
Cunningham, David ;
Atkin, Wendy ;
Lenz, Heinz-Josef ;
Lynch, Henry T. ;
Minsky, Bruce ;
Nordlinger, Bernard ;
Starling, Naureen .
LANCET, 2010, 375 (9719) :1030-1047