Occult neoplastic cells in the lymph node sinuses and recurrence/metastasis of stage III/Dukes' C colorectal cancer

Sekido, Yasutomo; Mukai, Masaya; Kishima, Kyoko; Tajima, Takayuki; Hoshikawa, Tatsuhiko; Nakamura, Masato; Nakamura, Naoya; Ogoshi, Kyoji

doi:10.3892/or.2011.1183

Cited by 6 publications

(9 citation statements)

References 21 publications

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“…Colorectal cancer patients with lymph node metastases (stage IIIA or higher) are considered to have systemic disease, similar to breast cancer patients, and ~30–40% of them are presumed to be at high-risk of recurrence, while the remaining 60–70% belong to the low-risk group (14,15). In patients with stage III colorectal cancer, it is presumed that numerous free tumor cells have dispersed into the portal circulation and reached the liver, lungs and other organs, unlike the patients who have stage II/N0 localized tumors.…”

Section: Discussionmentioning

confidence: 99%

“…However, among patients showing recurrence of stage III/Dukes’ C colorectal cancer with lymph node metastasis, >70–80% have ONCs. This strongly suggests a correlation between ONCs and recurrence/metastasis (14,15). ONCs may be classified as single cells, clusters (2–10 cells forming a cluster <0.2 mm in diameter) and aggregates (>10 cells).…”

Section: Introductionmentioning

confidence: 87%

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Occult neoplastic cells in lymph node sinuses and recurrence/metastasis of stage II/III gastric cancer

et al. 2013

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In the present study, we investigated the correlation between the presence of occult neoplastic cells (ONCs) in lymph node sinuses and recurrence/metastasis of stage II/III gastric cancer in 164 patients who underwent radical curative resection. We calculated the five-year relapse-free survival rate (5Y-RFS) and five-year overall survival rate (5Y-OS) of the ONC(+) and ONC(−) groups. The 5Y-RFS was 71.4% in the ONC(−) group and 47.5% in the ONC(+) group (P=0.003). The 5Y-OS was 68.8 and 48.4%, respectively (P=0.008). ONCs were found in 34.8% of stage II patients and were also detected in 66.7% of stage III patients. For distinguishing between the recurrence and non-recurrence groups, the sensitivity of ONC(+) was 64.5% (40/62; P=0.003), the positive predictive value (PPV) was 49.4% (40/81), the specificity was 59.8% (61/102) and the negative predictive value (NPV) was 73.5% (61/83). This high sensitivity indicates that ONC positivity may be a significant indicator for high-risk patients in the early postoperative period, and a lack of ONCs may be a useful indicator for identifying low-risk patients, as patients without ONCs had a high NPV.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 87%

Occult neoplastic cells in lymph node sinuses and recurrence/metastasis of stage II/III gastric cancer

et al. 2013

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“…It has been reported that a true survival benefit is achieved when there is improvement of survival after recurrence (21)(22)(23). thus, it may be important during postoperative adjuvant chemotherapy to accurately detect occult systemic disease by identification of viable free cancer cells such as floating clusters and aggregates, and to eliminate these cells in the perioperative period before distant metastasis/ recurrence occurs (29,30). It would be ideal to use targeted multi-drug combination regimens for adjuvant chemotherapy along with the standard 5-FU-based anticancer agents to attain sufficient efficacy (15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

“…Various studies have found a close relationship between recurrence/metastasis and floating occult neoplastic cells (oncs) detected by cytokeratin immunohistochemistry in the sinuses of lymph nodes distant from the primary tumor (24)(25)(26)(27)(28). oncs can be counted after immunostaining, which identifies these malignant cells trapped in the lymph node sinuses in a part of the body's immune defense mechanism (22,23) (29,30). In particular, ONCs classified as single cells + clusters in patients with stage III colorectal cancer show a high sensitivity/high specificity/high negative predictive value for distant metastasis/recurrence.…”

Section: Discussionmentioning

confidence: 99%

Is the T1/2N1 (≤3 nodes) category actually stage IIIA (TNM)/IIIa (Japanese classification) in patients with primary colorectal cancer?

Mukai

Kishima²,

Fukumitsu³

et al. 2011

Oncol Rep

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Abstract. the 5-year relapse-free survival rate (5y-rFs) and the 5-year overall survival rate (5y-os) were calculated for 972 patients (stage I, 206 IntroductionIn recent years, the outcome of patients with primary colorectal cancer in Japan has shown marked improvement with the development of more effective surgical techniques and adjuvant modalities such as chemotherapy and radiation therapy. It has been reported that the 5-year survival rate of patients after curative resection of Dukes' B/stage II colorectal cancer without lymph node metastases is approximately 80-85% (colon, 84.5±2.8%; rectum, 79.8±4.0%) (1-3). on the other hand, the 5-year survival rate of patients with Duke's c/ stage III cancer and lymph node metastases is approximately 60-70% (colon, 74.0±3.5%; rectum, 64.7±4.3%) (1-3). even after curative resection, approximately 30-40% of these patients eventually suffer the life-threatening development of distant metastasis/recurrence. According to the tnM classification, colorectal cancer patients with lymph node metastasis are classified as stage III, which is further divided into stage IIIA (T1/2N1, ≤3 metastatic nodes), stage IIIB (T3/4aN1) and stage IIIc based on the number of metastatic nodes (4). In the 7th edition of the general rules for clinical and pathological studies on cancer of the colon, rectum and Anus (grcpsc; Japanese classification) published in 2006, considerable changes have been made. thus, instead of the Japanese classification being based on the sites of lymph node metastasis, a more specific classification based on the number of lymph node metastases is now employed. According to the revised rules, N1 patients (≤3 nodes) and N2 patients (≥4 nodes) are classified as stage IIIa and IIIb, respectively, regardless of their t factor (5). lymph node metastasis in breast cancer patients is generally considered to be a manifestation of systemic disease, therefore breast cancer stages are subcategorized according to the number of involved lymph nodes. this also reflects the viewpoint that, in various cancers, the number of lymph node metastases is an important prognostic factor that determines the outcome and the survival of the patient (4,6-8). Abbreviations: 5y-rFs, 5-year relapse-free survival; 5y-os, 5-year overall survival; grcpsc, general rules for clinical and pathological studies on cancer of the colon, rectum and Anus;

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“…Detection of such tumor spread is considered to be extremely difficult by macroscopic examination during surgery or even by pathological examination of intraoperative frozen sections for verification of the resection margin. Therefore, it is most important to perform detailed examination of the surgical specimens from patients with Ra/ Rb cancer and lymph node involvement (e.g., by immunohistochemical staining of the mesorectum and surgical margins) and to identify patients with a high risk of recurrence in the early postoperative period (19,20). Patients in the high-risk group need stronger chemoradiotherapy as postoperative adjuvant therapy, additional radiotherapy for the pelvic floor or sacrum, and molecular-targeting agents combined with FOLFOX to control tumor growth (17)(18)(19)(20).…”

Section: Discussionmentioning

confidence: 99%

Stage II/III cancer of the rectosigmoid junction: An independent tumor type?

Mukai

Kishima²,

Yamazaki³

et al. 2011

Oncol Rep

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Abstract.The 5-year relapse-free survival rate (5Y-RFS) and 5-year overall survival rate (5Y-OS) were investigated in 766 patients with stage II/III colorectal cancer (CRC). The Stage II group included 283 patients with colon cancer (CC), 40 patients with rectosigmoid junction cancer (RSC), and 74 patients with rectal cancer (RC), while the Stage III group comprised 226 patients with CC, 52 patients with RSC, and 91 patients with RC. Stage III patients with RC were further divided into 68 patients with Ra cancer (Ra, rectum/above the peritoneal reflection) and 23 patients with Rb cancer (Rb, rectum/below the peritoneal reflection). Then the 5Y-RFS and 5Y-OS were calculated for each category or subcategory. The 5Y-RFS/5Y-OS was 80.3/80.6% for Stage II patients and 63.7% (p<0.001)/66.2% (p<0.001) for Stage III patients. In the Stage II group, the survival rates were 82.9/81.2% for CC, 77.6/74.8% for RSC, and 72.9/80.5% for RC, with no significant differences between each category. In the Stage III group, the survival rates were 69.3/72.8% for CC, 71.6/77.7% for RSC, and 46.5/46.2% for RC. There was no significant difference of survival for CC vs. RSC, but significant differences were noted for CC vs. RC (p<0.001/p<0.001) and RSC vs. RC (p=0.008/p=0.007). In the Stage III group, survival rates were 71.6/77.7% for RSC, 47.6/44.8% for Ra, and 45.7/51.3% for Rb, with significant differences for RSC vs. Ra (p=0.013/ p=0.005) and RSC vs. Rb (p=0.026/p=0.180), but not for Ra vs. Rb. These results suggest that Stage II/III RS cancer should be classified as colon cancer and should not be considered an independent tumor type.

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Occult neoplastic cells in the lymph node sinuses and recurrence/metastasis of stage III/Dukes' C colorectal cancer

Cited by 6 publications

References 21 publications

Occult neoplastic cells in lymph node sinuses and recurrence/metastasis of stage II/III gastric cancer

Occult neoplastic cells in lymph node sinuses and recurrence/metastasis of stage II/III gastric cancer

Is the T1/2N1 (≤3 nodes) category actually stage IIIA (TNM)/IIIa (Japanese classification) in patients with primary colorectal cancer?

Stage II/III cancer of the rectosigmoid junction: An independent tumor type?

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