title: Central mesenteric lymph node BER-Ep4+ cells in colorectal cancer: challenge to sentinel node concept?
abstract: 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.
authors: Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. schurr@uke.uni-hamburg.de
authors: Paulus G
authors: PG
authors: Schurr
authors: Sophia
authors: S
authors: Behnke
authors: Jussuf T
authors: JT
authors: Kaifi
authors: Dean
authors: D
authors: Bogoevski
authors: Bjoern
authors: B
authors: Link
authors: Oliver
authors: O
authors: Mann
authors: Tim
authors: T
authors: Strate
authors: Klaus
authors: K
authors: Pantel
authors: Jakob R
authors: JR
authors: Izbicki
authors: Emre
authors: E
authors: Yekebas
mesh_terms: 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
chemical_list: D014408:Biomarkers, Tumor; C115012:human epithelial antigen-125; D000951:Antigens, Neoplasm