Prognostic Impact of Micrometastases in Colon Cancer

Abstract

This is the first prospective evaluation of the prognostic impact of MM in colorectal cancer. These results indicate that the detection of MM may be clinically relevant in CC and may improve the selection of patients for adjuvant systemic chemotherapy. Patients with CC who are node negative by cumulative detection methods (H&E/IHC and qRT) are likely to be cured by surgery alone.

Surgical Quality and Nodal Ultrastaging Is Associated With Long-Term Disease-Free Survival in Early Colorectal Cancer

“…Two hundred fifty-three patients provided written informed consent and were enrolled over a 6-year study period in two prospective multi-center clinical trials of LN ultra-staging in CRC 12, 17. Eligibility criteria have been previously described 12, 17.…”

“…Eligibility criteria have been previously described 12, 17. In brief, study subjects were adults (18 years of age or older) with potentially curable primary non-metastatic colon (n=217) or rectal (n=36) carcinoma detected by endoscopy.…”

“…The clinical relevance of MM detected by pancytokeratin immunohistochemistry (pan-CK-IHC) found to be negative by H&E staining in patients with colon cancer 16 have not however been uniformly accepted. Our group has demonstrated the utility of ultra-staging with nodal step sections and pan-CK-IHC for the detection of occult nodal disease, and has underscored the potential prognostic impact of MM in our ongoing efforts to not only standardize the surgical and pathological evaluation, but also improve patient selection for adjuvant therapy of Stage II colon cancer 12,13,17,18. The present analysis of two international prospective trials was undertaken to assess the impact of surgical quality and nodal ultra-staging on long-term disease-free survival (DFS) in early CRC.…”

“…These undetected micrometastases (MM) may account for the high (20-30%) rate of disease recurrence after surgical resection of Stage II colon cancer 12,13. The clinical relevance of MM detected by pancytokeratin immunohistochemistry (pan-CK-IHC) found to be negative by H&E staining in patients with colon cancer 16 have not however been uniformly accepted.…”

The Current Role of Sentinel Lymph Node Biopsy in Breast, Melanoma, and Gastrointestinal Cancers

“…Our group recently reported interim results regarding the prognostic impact of micrometastases, and a mean follow-up of 25 months in 152 CRC patients found no recurrences in patients deemed nodenegative after SLNB by H&E, IHC, and RT-PCR compared with six recurrences in patients who were tumor-node-positive according to IHC or RT-PCR staining. 43 Lim et al found equivalent outcomes in patients with SNs positive by IHC only compared with those who were truly node-negative. 42 Additional issues regarding SLNB in CRC patients include the need for considerable surgeon experience, a variable false-negative rate with frequently aberrant lymphatic anatomy, and the marginal results achieved in patients with rectal cancer.…”