Prognostic impact of para-aortic lymph node micrometastasis in patients with regional node-positive biliary cancer.
BACKGROUND
The presence of para-aortic lymph node metastasis in biliary cancer has a negative impact on prognosis. The relevance of para-aortic lymph node micrometastasis is unknown.


METHODS
A total of 546 para-aortic lymph nodes from 49 patients with biliary cancer with positive regional nodes and negative para-aortic nodes were immunostained with epithelial marker CAM5.2 (specific for cytokeratins 7 and 8). Immunostained tumour foci were classified as micrometastases or isolated tumour cells (ITCs) according to their size (larger or smaller than 0.2 mm).


RESULTS
CAM5.2-positive occult carcinoma cells in para-aortic lymph nodes were detected in nine (18 per cent) of 49 patients and in 18 (3.3 per cent) of 546 para-aortic nodes. There was no difference in postoperative survival between patients with and without CAM5.2-positive para-aortic nodes (P = 0.978), but survival for five patients with micrometastases was significantly worse than that for four patients with only ITCs (P = 0.047).


CONCLUSIONS
In patients with regional node-positive and para-aortic node-negative biliary cancer, and occult cancer cells in para-aortic lymph nodes, prognosis was significantly worse in those with micrometastases than in patients with only ITCs. An efficient method of intraoperative detection of para-aortic lymph node micrometastases larger than 0.2 mm is needed.
Department of Surgical Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
A
A
Yonemori
S
S
Kondo
Y
Y
Matsuno
T
T
Ito
E
E
Tanaka
S
S
Hirano
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta; D001661:Biliary Tract Neoplasms / Q000401:mortality* / Q000601:surgery; D015415:Biomarkers / Q000378:metabolism*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D007633:Keratins / Q000378:metabolism*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D013997:Time Factors
D015415:Biomarkers; C400901:CAM 5.2 antigen; D007633:Keratins