Predicting recurrence and metastasis of stage III/Dukes' C colorectal cancer with lymph node metastasis

Abstract. The aim of this study was to retrospectively evaluate the effect of adding CPT-11 to postoperative chemotherapy for stage III colorectal cancer. The subjects were 94 patients, including 60 in stage IIIa (≤3 positive nodes) and 34 in stage IIIb (≥4 positive nodes), who underwent curative resection. The clinical outcome was compared between patients receiving 5-FU/LV plus CPT-11 (FLC group) and patients receiving 5-FU/LV alone (FL group). The FLC group (54 patients) had a 3-year relapse-free survival (3Y-RFS) of 68.7%, a 5Y-RFS of 68.7% and a 5Y-OS of 67.1%, while the FL group (40 patients) had a 3Y-RFS of 67.5% (n.s.), a 5Y-RFS of 64.9% (n.s.), and a 5Y-OS of 77.3% (n.s.). There were no significant differences of these parameters between the two groups. For stage IIIa patients, the corresponding survival rates were 92.4, 92.4 and 90.9% in the FLC group (29 patients) vs. 64.5% (p=0.024), 61.1% (p=0.018), and 77.1% (n.s.) in the FL group (31 patients). For stage IIIb patients, the rates were 36.6, 36.6 and 24.8% in the FLC group (25 patients) vs. 77.8% (n.s.), 77.8% (n.s.), and 77.8% (n.s.) in the FL group (9 patients). These results suggest that the 3Y-RFS and 5Y-RFS of patients with stage IIIa colorectal cancer were significantly improved by adjuvant chemotherapy with 5-FU/LV plus CPT-11.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy of 5-FU/LV plus CPT-11 as first-line adjuvant chemotherapy for stage IIIa colorectal cancer

Mukai

Okada²,

Fukumitsu³

et al. 2009

“…It is also known that colorectal cancer may cause fatal metastasis/recurrence in the liver or lungs after curative resection of the primary tumor, probably because free cancer cells circulate during the perioperative period and survive to proliferate in a distant organ after escaping from the immune system (8)(9)(10)(11). Many investigators have reported that cytokeratin-positive occult neoplastic cells (ONCs), which represent circulating cancer cells, in lymph node sinuses distant from the primary tumor are closely related to the distant metastasis/recurrence of cancer (12)(13)(14)(15)(16)(17)(18)(19). ONCs can be counted by immunostaining and represent floating malignant cells that have been trapped by the lymph nodes (8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Alternating hepatic arterial infusion and systemic chemotherapy for stage IV colorectal cancer with synchronous liver metastasis

Mukai

Oida²,

Tajima³

et al. 2006

Self Cite

Abstract. Among 41 patients with synchronous liver metastases of colorectal cancer, 15 patients underwent synchronous resection of their liver metastases and achieved a median survival time (MST) of 1,441 days (versus 748 days for the 26 patients without resection, p=0.038), a median relapse-free survival time of 652 days (MST not reached), and a recurrence rate in the residual liver of 20% (3/15 patients). The alternating hepatic arterial infusion and systemic chemotherapy showed partial response (PR) in 6 cases, stable disease (SD) in 8 cases, and progressive disease (PD) in 1 case (n=15/26). They had an objective response rate of 40% (6/15), tumor control rate (≥ SD) of 93.3% (14/15), one-year progression-free survival rate of 35.7%, 50% time to progression of 270 days, one-year survival rate of 76.2%, and two-year survival rate of 50.8% (MST not reached). Grade 3 leucopenia was observed in 2/15 patients (13.3%). These results suggest that the present alternating therapy may become a standard regimen for patients in whom synchronous resection of liver metastases is impossible and patients who have stage IV colorectal cancer with a risk of recurrence in the remnant liver and/or at extrahepatic sites such as the lungs.

“…According to the pathological concept of breast cancer, positive lymph node metastasis indicates systemic disease with the potential for metastasis to other organs and the presence or absence of lymph node metastasis is considered to be one of the most important clinical markers (5,6). Hematogenous metastasis to the liver or the lungs in patients with lymph node metastasis who undergo curative resection is presumed to occur when cancer cells circulating in the blood during the perioperative period, escape the immune system enter the microcirculation of the liver or the lungs, and find appropriate microenvironment for growth and proliferation (7)(8)(9)(10). Various reports have been published about the close relationship between recurrence/metastasis of cancer and detection of occult neoplastic cells (ONCs) positive for cytokeratin immunohistochemical staining and floating in the sinuses of lymph nodes distant from the primary tumors (11)(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

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

Sekido

Mukai²,

Kishima³

et al. 2011

Abstract.Lymph nodes from patients with colorectal cancer were immunohistochemically stained for cytokeratin to investigate the relationship between the presence of occult neoplastic cells (ONCs) and recurrence/metastasis. A total of 80 patients with stage III/Dukes' C colorectal cancer were divided into 16 patients who developed recurrence/metastasis (recurrence group) and 64 patients without recurrence (nonrecurrence group). ONCs were compared between the two groups with respect to i) single cells (≥3 floating ONCs), ii) clusters of cells (1 or more floating aggregates of 2-20 ONCs) and iii) single cells + clusters. When single cells were detected, the sensitivity for recurrence was 87.5% (14/16, p=0.002), the positive predictive value (PPV) was 32.6% (14/43), the specificity was 54.7% (35/64) and the negative predictive value (NPV) was 94.6% (35/37). For clusters, the sensitivity was 87.5% (14/16, p<0.001), PPV was 41.2% (14/34), specificity was 68.8% (44/64) and NPV 95.7% (44/46). With single cells + clusters, the values were 87.5% (14/16, p<0.001), 48.3% (14/29), 76.6% (49/64) and 96.1% (49/51), respectively. These results suggest that the detection of single cells + clusters is a sensitive indicator of a high risk of recurrence/metastasis, while ONCs are useful for identifying the low-risk group of patients with stage III colorectal cancer. IntroductionThe 5-year survival rate of Japanese patients who have stage II/ Dukes' B colorectal cancer without lymph node metastasis and receive curative resection is approximately 80% (colon, 84.5±2.8%; rectum, 79.8±4.0%), whereas the 5-year survival rate is considerably lower at approximately 60% (colon, 74.0±3.5%; rectum, 64.7±4.3%) for patients with stage III/ Dukes' C colorectal cancer and lymph node metastasis who undergo curative resection (1-4). Thus, recurrence/metastasis develops in 30-40% of stage III/Dukes' C patients after curative resection and can be fatal (2,4). According to the pathological concept of breast cancer, positive lymph node metastasis indicates systemic disease with the potential for metastasis to other organs and the presence or absence of lymph node metastasis is considered to be one of the most important clinical markers (5,6). Hematogenous metastasis to the liver or the lungs in patients with lymph node metastasis who undergo curative resection is presumed to occur when cancer cells circulating in the blood during the perioperative period, escape the immune system enter the microcirculation of the liver or the lungs, and find appropriate microenvironment for growth and proliferation (7-10). Various reports have been published about the close relationship between recurrence/metastasis of cancer and detection of occult neoplastic cells (ONCs) positive for cytokeratin immunohistochemical staining and floating in the sinuses of lymph nodes distant from the primary tumors (11-15). ONCs can be semiquantified by a relatively simple immunostaining method and represent floating tumor cells target trapped in the microcirculation of the lymph node...