title: Para-aortic lymph node micrometastasis in patients with node-negative biliary cancer.
abstract: OBJECTIVE
  The presence of para-aortic lymph node metastasis in biliary cancer negatively impacts prognosis. The present study aims to immunohistochemically identify and evaluate the clinical significance of para-aortic lymph node micrometastases in 66 patients who had undergone curative resection of biliary cancer.
  
  
  METHODS
  We used an antibody against cytokeratins 7 and 8 (CAM5.2) to immunostain 529 para-aortic lymph nodes that were negative according to conventional analysis from 66 patients with biliary cancer.
  
  
  RESULTS
  We detected CAM5.2-positive occult carcinoma cells in para-aortic lymph nodes from 3 (5%) of the 66 patients and in 3 (0.6%) of the 529 para-aortic lymph nodes. One of the 3 patients also had micrometastasis in the regional lymph nodes. All 3 patients with para-aortic lymph node micrometastasis are alive at 45, 48 and 90 months after surgery despite having locally advanced cancer.
  
  
  CONCLUSIONS
  Occult cancer cells were identified in para-aortic lymph nodes from 5% of patients with node-negative biliary cancer, yet these patients have survived over the long term. The presence of para-aortic nodal micrometastasis might not have an influence on survival. However, further studies using a greater number of patients are required to support this notion.
authors.affiliation: Division of Cancer Medicine, Department of Surgical Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. a-yone @ kushiro.jrc.or.jp
authors.forename: Atsuya
authors.initials: A
authors.lastname: Yonemori
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kondo
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Matsuno
authors.forename: Tomoo
authors.initials: T
authors.lastname: Ito
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tanaka
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000473:pathology* / Q000601:surgery; D015415:Biomarkers / Q000032:analysis*; D002277:Carcinoma / Q000378:metabolism / Q000556:secondary* / Q000601:surgery; D018281:Cholangiocarcinoma / Q000378:metabolism / Q000556:secondary / Q000601:surgery; D005260:Female; D005706:Gallbladder Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D007633:Keratins / Q000032:analysis*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; C400901:CAM 5.2 antigen; D007633:Keratins