title: Prognostic value of the detection of lymph node micrometastases in colon cancer.
abstract: OBJECTIVE
  A study is made of the clinical repercussions of occult metastases-micrometastases (MMs+)-or isolated tumour cells (ITCs+) in the lymph nodes of patients with stage IIA and IIB colon adenocarcinoma initially considered as corresponding to N0.
  
  
  METHODS
  A retrospective study of 39 patients with stage IIA and IIB (T3-T4 N0 M0) colon adenocarcinoma, subjected to similar surgical and adjuvant chemotherapy treatment, with long and careful follow-up (minimum: 5 years, mean: 81.7 months) was performed on their previously resected lymph nodes, with the aid of new histological and immunohistochemical (cytokeratin) sections, in order to detect MMs or ITCs. Disease-free survival (DFS) and global survival (GS) in the two groups (patients with MMs+ or ITCs+ vs. patients without MMs or ITCs) were compared at 5 years based on the corresponding Kaplan-Meier survival curves, with the Breslow test.
  
  
  RESULTS
  A total of 382 lymph nodes from the 39 patients (mean: 9.8; standard deviation: 6.09) were revised. MMs+ were detected in 2 cases and ITCs+ in 2 more cases on the Cytokeratin study. GS of the whole series at 5 years was 89.74% (35 patients alive) with a DFS at 5 years of 79.49% (31 patients free of disease), but the 2 cases with MMs+ were dead at 5 years, with high statistical differences between both groups (MMs+/MMs-) (p<0.0001). When comparing the group of MMs+/ITCs+ patients and the group of MM-/ITCs- patients, the DFS and GS times at 5 years were higher in the MMs-/ITCs- group (p=0.0692 and p=0.006 respectively).
  
  
  CONCLUSIONS
  Although the incidence of MMs+ or ITCs+ in the examined lymph nodes was low, the presence of MMs is related to a dramatic reduction in GS and DFS at 5 years. We encourage a detailed histological study of lymph nodes resected in patients with deep penetrating colon tumours in order to assure a pN0 status.
authors.affiliation: Medical Oncology Unit, Dr. Peset University Hospital, Valencia, Spain. bosch_car@gva.es
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Bosch Roig
authors.forename: Ester
authors.initials: E
authors.lastname: Roselló-Sastre
authors.forename: Sonia
authors.initials: S
authors.lastname: Alonso Hernández
authors.forename: Daniel
authors.initials: D
authors.lastname: Almenar Cubells
authors.forename: Enrique
authors.initials: E
authors.lastname: Grau Cardona
authors.forename: Natalia
authors.initials: N
authors.lastname: Camarasa Lillo
authors.forename: Daniel
authors.initials: D
authors.lastname: Bautista
authors.forename: Carmen
authors.initials: C
authors.lastname: Molins Palau
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary* / Q000601:surgery; D002288:Adenocarcinoma, Mucinous / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D007633:Keratins / Q000378:metabolism; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D007633:Keratins
references.citation: Eur J Surg. 1996 Aug;162(8):637-42
references.pmid: 8891622
references.citation: J Clin Oncol. 1999 Sep;17(9):2896-900
references.pmid: 10561368
references.citation: Ann Surg Oncol. 2003 Jan-Feb;10(1):65-71
references.pmid: 12513963
references.citation: J Clin Oncol. 2003 Aug 1;21(15):2912-9
references.pmid: 12885809
references.citation: Cancer. 2003 Dec 15;98(12):2740-1
references.pmid: 14669301
references.citation: Mod Pathol. 2004 Apr;17(4):402-6
references.pmid: 14976530
references.citation: Ann Intern Med. 1995 Mar 1;122(5):321-6
references.pmid: 7847642
references.citation: Arch Surg. 1989 Feb;124(2):180-2
references.pmid: 2916939
references.citation: Dis Colon Rectum. 1997 Dec;40(12):1465-71
references.pmid: 9407986
references.citation: J Clin Oncol. 2002 Oct 15;20(20):4232-41
references.pmid: 12377967
references.citation: J Surg Oncol. 2004 Mar;85(3):166-70
references.pmid: 14991889
references.citation: Cancer. 1994 Feb 1;73(3):563-9
references.pmid: 7507795
references.citation: CA Cancer J Clin. 2004 Nov-Dec;54(6):295-308
references.pmid: 15537574
references.citation: J Pathol. 1994 Feb;172(2):183-7
references.pmid: 7513353
references.citation: JAMA. 1990 Sep 19;264(11):1444-50
references.pmid: 2202842
references.citation: Dis Colon Rectum. 1991 Oct;34(10):917-20
references.pmid: 1717210
references.citation: J Natl Cancer Inst. 2005 Feb 2;97(3):219-25
references.pmid: 15687365
references.citation: Clin Transl Oncol. 2006 Sep;8(9):676-80
references.pmid: 17005470
references.citation: Int J Colorectal Dis. 1998;13(2):99-102
references.pmid: 9638496
references.citation: Colorectal Dis. 2003 Mar;5(2):164-8
references.pmid: 12780907
references.citation: J Clin Oncol. 2004 Aug 15;22(16):3408-19
references.pmid: 15199089
references.citation: Dis Colon Rectum. 1998 Oct;41(10):1244-9
references.pmid: 9788387
references.citation: Ann Surg Oncol. 2001 May;8(4):300-4
references.pmid: 11352302
references.citation: N Engl J Med. 1998 Jul 23;339(4):223-8
references.pmid: 9673300