Central mesenteric lymph node BER-Ep4+ cells in colorectal cancer: challenge to sentinel node concept?
BACKGROUND
The role of sentinel lymph nodes in colorectal cancer remains unclear.


METHODS
Cryosections from central para-aortic mesenterial lymph nodes were stained using mAb BER-Ep4. Overall survival and distant recurrence were calculated using Kaplan-Meier plots.


RESULTS
All patients (n = 48) were free of distant metastases and curatively resected (R0). 23 pN0, 13 pN1 and 12 pN2 stages were found. 21/48 patients (44%) showed BER-Ep4+ cells in their central lymph nodes (7/23 pN0, 8/13 pN1, 6/12 pN2). In 6/23 pN0 patients, BER-Ep4+ cells were also found in locoregional nodes (p = 0.03, Fisher's exact test). pN status predicted overall survival (p = 0.006, Kaplan-Meier curve, log-rank test). An impact was exerted by central mesenteric BER-Ep4+ cells on overall survival (p = 0.009 in pN0 patients, p = 0.07 for all pN) and distant recurrence-free survival (p = 0.001 in pN0 patients, p = 0.007 for all pN). Multivariate analysis showed an independent prognostic effect on overall survival in pN0 patients (p = 0.022).


CONCLUSIONS
Central lymph nodes are sentinels of disease not amenable to extended lymphadenectomy and might identify patients at risk of distant organ recurrence.
Schurr
Paulus G
PG
Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. schurr@uke.uni-hamburg.de
Behnke
Sophia
S
Kaifi
Jussuf T
JT
Bogoevski
Dean
D
Link
Bjoern
B
Mann
Oliver
O
Strate
Tim
T
Pantel
Klaus
K
Izbicki
Jakob R
JR
Yekebas
Emre
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis*; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D021701:Sentinel Lymph Node Biopsy; D016019:Survival Analysis; D000951:Antigens, Neoplasm
D014408:Biomarkers, Tumor; C115012:human epithelial antigen-125; D000951:Antigens, Neoplasm