Excellent prognosis of node negative patients after sentinel node procedure in colon carcinoma: a 5-year follow-up study.
OBJECTIVE
Investigate the prognostic impact and clinical relevance of the sentinel node (SN)-procedure in colon carcinoma.


METHODS
Between May 2002 and January 2004, the SN-procedure was performed in 55 patients that underwent elective resection for clinically non-advanced colon carcinoma. A control group of 110 patients was identified from a cohort between January 2000 and April 2002. All lymph nodes were analysed by conventional haematoxylin-eosin staining. All negative SNs underwent in-depth analysis using immunohistochemical-staining and automated microscopy with the Ariol-system. Patients with positive lymph nodes were offered adjuvant chemotherapy. All patients were routinely monitored at 6-month intervals and follow-up was more than 5 years.


RESULTS
The SN was successfully identified in 98% of the patients, with 94% sensitivity. In-depth analysis with immunohistochemistry and automated microscopy (Ariol-system) upstaged 3 and 4 patients respectively. When only node-negative patients were analysed, overall 5-year-survival was significantly better in the SN group (91% vs. 76%, p = 0.04). Cancer-specific-mortality was even 0% (vs. 8%, p = 0.08). Disease-free-survival was significantly improved to 96% (vs. 77%, p < 0.01).


CONCLUSIONS
This study describes the prognostic impact of the SN-procedure in colon carcinoma after 5-year-follow-up. Only one patient had recurrent disease after a negative SN procedure (disease-free-survival 96%). These results indicate that the SN-procedure is of prognostic relevance and might be useful to select patients for adjuvant chemotherapy. Patients that are lymph node negative after an SN-procedure have an excellent prognosis and do not need adjuvant treatment.
Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. Electronic address: a.e.braat@lumc.nl.
A E
AE
Braat
Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
R A
RA
Pol
Department of Surgery, VU Medical Centre, P.O. Box 7075, 1007 MB Amsterdam, The Netherlands.
J W A
JW
Oosterhuis
Department of Surgery, Isala Klinieken, Locatie Sophia, Dokter van Heesweg 2, P.O. Box 10400, 8000 GK Zwolle, The Netherlands.
J E
JE
de Vries
Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
W E
WE
Mesker
Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
R A E M
RA
Tollenaar
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D003110:Colonic Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D015996:Survival Rate
Colonic neoplasms; Colorectal neoplasms; Follow-up studies; Lymphatic metastasis; Neoplasm staging; Sentinel lymph node biopsy