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Published in: International Journal of Colorectal Disease 8/2007

01-08-2007 | Original Article

Isolated tumor cell in lateral lymph node has no influences on the prognosis of rectal cancer patients

Authors: M. Hara, T. Hirai, H. Nakanishi, Y. Kanemitsu, K. Komori, M. Tatematsu, T. Kato

Published in: International Journal of Colorectal Disease | Issue 8/2007

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Abstract

Background and aims

The aim of this study was to determine the incidence of isolated tumor cells (ITC) and micrometastasis in lateral lymph nodes of patients with rectal cancer and its possible correlation with prognosis.

Materials and methods

One hundred seventy-seven rectal cancer patients who underwent curative resection with lateral lymph node dissection were enrolled. Dissected lymph nodes were examined using hematoxylin–eosin staining (HE) and immunohistochemistry (IHC) with anti-keratin antibody (AE1/AE3). States of lymph node metastasis were divisible into three groups: detectable with HE (HE+), detectable with only IHC (HE−/IHC+), and undetectable even with IHC (IHC−). Almost all the HE−/IHC+ group was classified as ITC consisting of a few tumor cells according to the UICC criteria (ITC+). Survival rates were compared among HE+, ITC+, and IHC−.

Results

ITC+ were detected in 24.1% of patients with HE-negative lateral lymph nodes. No significant difference in overall 5-year survival was observed between ITC+ and IHC− patients (76.1 and 82.9%, respectively, p = 0.25). Multivariate analysis showed that perirectal HE+ lymph nodes, but not ITC+ lateral lymph nodes, was an independent prognostic factor.

Conclusions

ITC in lateral lymph nodes does not contribute to the prognosis of rectal cancer in patients who undergo extended lateral lymph node dissection, unlike HE+ lateral lymph node metastasis.
Literature
1.
go back to reference Creasman WT, DeGeest K, DiSaia PJ, Zaino RJ (1999) Significance of true surgical pathologic staging: a Gynecologic Oncology Group Study. Am J Obstet Gynecol 181:31–34PubMedCrossRef Creasman WT, DeGeest K, DiSaia PJ, Zaino RJ (1999) Significance of true surgical pathologic staging: a Gynecologic Oncology Group Study. Am J Obstet Gynecol 181:31–34PubMedCrossRef
2.
go back to reference Bochner BH, Herr HW, Reuter VE (2001) Impact of separate versus en bloc pelvic lymph node dissection on the number of lymph nodes retrieved in cystectomy specimens. J Urol 166:2295–2296PubMedCrossRef Bochner BH, Herr HW, Reuter VE (2001) Impact of separate versus en bloc pelvic lymph node dissection on the number of lymph nodes retrieved in cystectomy specimens. J Urol 166:2295–2296PubMedCrossRef
3.
go back to reference Heidenreich A, Varga Z, Von Knobloch R (2002) Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis. J Urol 167:1681–1686PubMedCrossRef Heidenreich A, Varga Z, Von Knobloch R (2002) Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis. J Urol 167:1681–1686PubMedCrossRef
4.
5.
go back to reference Stearns MW Jr, Deddish MR (1959) Five-year results of abdominopelvic lymph node dissection for carcinoma of the rectum. Dis Colon Rectum 2:169–172PubMedCrossRef Stearns MW Jr, Deddish MR (1959) Five-year results of abdominopelvic lymph node dissection for carcinoma of the rectum. Dis Colon Rectum 2:169–172PubMedCrossRef
6.
go back to reference Havenga K, Enker WE, Norstein J, Moriya Y, Heald RJ, van Houwelingen HC, van de Velde CJ (1999) Improved survival and local control after total mesorectal excision or D3 lymphadenectomy in the treatment of primary rectal cancer: an international analysis of 1411 patients. Eur J Surg Oncol 25:368–374PubMedCrossRef Havenga K, Enker WE, Norstein J, Moriya Y, Heald RJ, van Houwelingen HC, van de Velde CJ (1999) Improved survival and local control after total mesorectal excision or D3 lymphadenectomy in the treatment of primary rectal cancer: an international analysis of 1411 patients. Eur J Surg Oncol 25:368–374PubMedCrossRef
7.
go back to reference Carlsen E, Schlichting E, Guldvog I, Johnson E, Heald RJ (1998) Effect of the introduction of total mesorectal excision for the treatment of rectal cancer. Br J Surg 85:526–529PubMedCrossRef Carlsen E, Schlichting E, Guldvog I, Johnson E, Heald RJ (1998) Effect of the introduction of total mesorectal excision for the treatment of rectal cancer. Br J Surg 85:526–529PubMedCrossRef
8.
go back to reference MacFarlane JK, Ryall RD, Heald RJ (1993) Mesorectal excision for rectal cancer. Lancet 341:457–460PubMedCrossRef MacFarlane JK, Ryall RD, Heald RJ (1993) Mesorectal excision for rectal cancer. Lancet 341:457–460PubMedCrossRef
9.
go back to reference Delaney CP, Lavery IC, Brenner A, Hammel J, Senagore AJ, Noone RB, Fazio VW (2002) Preoperative radiotherapy improves survival for patients undergoing total mesorectal excision for stage T3 low rectal cancers. Ann Surg 236:203–207PubMedCrossRef Delaney CP, Lavery IC, Brenner A, Hammel J, Senagore AJ, Noone RB, Fazio VW (2002) Preoperative radiotherapy improves survival for patients undergoing total mesorectal excision for stage T3 low rectal cancers. Ann Surg 236:203–207PubMedCrossRef
10.
go back to reference Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van Krieken JH, Leer JW, van de Velde CJ (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646PubMedCrossRef Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van Krieken JH, Leer JW, van de Velde CJ (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646PubMedCrossRef
11.
go back to reference Bonnel C, Parc YR, Pocard M, Dehni N, Caplin S, Parc R, Tiret E (2002) Effects of preoperative radiotherapy for primary resectable rectal adenocarcinoma on male sexual and urinary function. Dis Colon Rectum 45:934–939PubMedCrossRef Bonnel C, Parc YR, Pocard M, Dehni N, Caplin S, Parc R, Tiret E (2002) Effects of preoperative radiotherapy for primary resectable rectal adenocarcinoma on male sexual and urinary function. Dis Colon Rectum 45:934–939PubMedCrossRef
12.
go back to reference Koyama Y, Moriya Y, Hojo K (1984) Effects of extended systematic lymphadenectomy for adenocarcinoma of the rectum-significant improvement of survival rate and decrease of local recurrence. Jpn J Clin Oncol 14:623–632PubMed Koyama Y, Moriya Y, Hojo K (1984) Effects of extended systematic lymphadenectomy for adenocarcinoma of the rectum-significant improvement of survival rate and decrease of local recurrence. Jpn J Clin Oncol 14:623–632PubMed
13.
go back to reference Sugihara K, Moriya Y, Akasu T, Fujita S (1996) Pelvic autonomic nerve preservation for patients with rectal carcinoma. Oncologic and functional outcome. Cancer 78:1871–1880PubMedCrossRef Sugihara K, Moriya Y, Akasu T, Fujita S (1996) Pelvic autonomic nerve preservation for patients with rectal carcinoma. Oncologic and functional outcome. Cancer 78:1871–1880PubMedCrossRef
14.
go back to reference Mori T, Takahashi K, Yasuno M (1998) Radical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: the impact of lateral lymph node dissection. Langenbecks Arch Surg 383:409–415PubMedCrossRef Mori T, Takahashi K, Yasuno M (1998) Radical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: the impact of lateral lymph node dissection. Langenbecks Arch Surg 383:409–415PubMedCrossRef
15.
go back to reference Greenson JK, Isenhart CE, Rice R, Mojzisik C, Houchens D, Martin EW Jr (1994) Identification of occult micrometastases in pericolic lymph nodes of Duke’s B colorectal cancer patients using monoclonal antibodies against cytokeratin and CC49. Correlation with long-term survival. Cancer 73:563–569PubMedCrossRef Greenson JK, Isenhart CE, Rice R, Mojzisik C, Houchens D, Martin EW Jr (1994) Identification of occult micrometastases in pericolic lymph nodes of Duke’s B colorectal cancer patients using monoclonal antibodies against cytokeratin and CC49. Correlation with long-term survival. Cancer 73:563–569PubMedCrossRef
16.
go back to reference Broll R, Schauer V, Schimmelpenning H, Strik M, Woltmann A, Best R, Bruch HP, Duchrow M (1997) Prognostic relevance of occult tumor cells in lymph nodes of colorectal carcinomas: an immunohistochemical study. Dis Colon Rectum 40:1465–1471PubMedCrossRef Broll R, Schauer V, Schimmelpenning H, Strik M, Woltmann A, Best R, Bruch HP, Duchrow M (1997) Prognostic relevance of occult tumor cells in lymph nodes of colorectal carcinomas: an immunohistochemical study. Dis Colon Rectum 40:1465–1471PubMedCrossRef
17.
go back to reference Isaka N, Nozue M, Doy M, Fukao K (1999) Prognostic significance of perirectal lymph node micrometastases in Dukes’ B rectal carcinoma: an immunohistochemical study by CAM5.2. Clin Cancer Res 5:2065–2068PubMed Isaka N, Nozue M, Doy M, Fukao K (1999) Prognostic significance of perirectal lymph node micrometastases in Dukes’ B rectal carcinoma: an immunohistochemical study by CAM5.2. Clin Cancer Res 5:2065–2068PubMed
18.
go back to reference Jeffers MD, O’Dowd GM, Mulcahy H, Stagg M, O’Donoghue DP, Toner M (1994) The prognostic significance of immunohistochemically detected lymph node micrometastases in colorectal carcinoma. J Pathol 172:183–187PubMedCrossRef Jeffers MD, O’Dowd GM, Mulcahy H, Stagg M, O’Donoghue DP, Toner M (1994) The prognostic significance of immunohistochemically detected lymph node micrometastases in colorectal carcinoma. J Pathol 172:183–187PubMedCrossRef
19.
go back to reference Adell G, Boeryd B, Franlund B, Sjodahl R, Hakansson L (1996) Occurrence and prognostic importance of micrometastases in regional lymph nodes in Dukes’ B colorectal carcinoma: an immunohistochemical study. Eur J Surg 162:637–642PubMed Adell G, Boeryd B, Franlund B, Sjodahl R, Hakansson L (1996) Occurrence and prognostic importance of micrometastases in regional lymph nodes in Dukes’ B colorectal carcinoma: an immunohistochemical study. Eur J Surg 162:637–642PubMed
20.
go back to reference Cutait R, Alves VA, Lopes LC, Cutait DE, Borges JL, Singer J, da Silva JH, Goffi FS (1991) Restaging of colorectal cancer based on the identification of lymph node micrometastases through immunoperoxidase staining of CEA and cytokeratins. Dis Colon Rectum 34:917–920PubMedCrossRef Cutait R, Alves VA, Lopes LC, Cutait DE, Borges JL, Singer J, da Silva JH, Goffi FS (1991) Restaging of colorectal cancer based on the identification of lymph node micrometastases through immunoperoxidase staining of CEA and cytokeratins. Dis Colon Rectum 34:917–920PubMedCrossRef
21.
go back to reference Shimoyama M, Yamazaki T, Suda T, Hatakeyama K (2003) Prognostic significance of lateral lymph node micrometastases in lower rectal cancer: an immunohistochemical study with CAM5.2. Dis Colon Rectum 46:333–339PubMedCrossRef Shimoyama M, Yamazaki T, Suda T, Hatakeyama K (2003) Prognostic significance of lateral lymph node micrometastases in lower rectal cancer: an immunohistochemical study with CAM5.2. Dis Colon Rectum 46:333–339PubMedCrossRef
22.
go back to reference Sobin LH (2003) TNM: evolution and relation to other prognostic factors. Sem Surg Oncol 21:3–7CrossRef Sobin LH (2003) TNM: evolution and relation to other prognostic factors. Sem Surg Oncol 21:3–7CrossRef
23.
go back to reference Sobin LH (2003) TNM, sixth edition: new developments in general concepts and rules. Sem Surg Oncol 21:19–22CrossRef Sobin LH (2003) TNM, sixth edition: new developments in general concepts and rules. Sem Surg Oncol 21:19–22CrossRef
24.
go back to reference Hermanek P, Hutter RV, Sobin LH, Wittekind C (1999) International Union Against Cancer. Classification of isolated tumor cells and micrometastasis. Cancer 86:2668–2673PubMedCrossRef Hermanek P, Hutter RV, Sobin LH, Wittekind C (1999) International Union Against Cancer. Classification of isolated tumor cells and micrometastasis. Cancer 86:2668–2673PubMedCrossRef
25.
go back to reference Sobin LH, Wittekind C (2002) TNM classification of malignant tumors, 6th edn. Wiley, New York Sobin LH, Wittekind C (2002) TNM classification of malignant tumors, 6th edn. Wiley, New York
26.
go back to reference Yasuda K, Adachi Y, Shiraishi N, Yamaguchi K, Hirabayashi Y, Kitano S (2001) Pattern of lymph node micrometastasis and prognosis of patients with colorectal cancer. Ann Surg Oncol 8:300–304PubMedCrossRef Yasuda K, Adachi Y, Shiraishi N, Yamaguchi K, Hirabayashi Y, Kitano S (2001) Pattern of lymph node micrometastasis and prognosis of patients with colorectal cancer. Ann Surg Oncol 8:300–304PubMedCrossRef
27.
go back to reference Tepper JE, O’Connell MJ, Niedzwiecki D, Hollis D, Compton C, Benson AB 3rd, Cummings B, Gunderson L, Macdonald JS, Mayer RJ (2001) Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol 19:157–163PubMed Tepper JE, O’Connell MJ, Niedzwiecki D, Hollis D, Compton C, Benson AB 3rd, Cummings B, Gunderson L, Macdonald JS, Mayer RJ (2001) Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol 19:157–163PubMed
28.
go back to reference Wong JH, Severino R, Honnebier MB, Tom P, Namiki TS (1999) Number of nodes examined and staging accuracy in colorectal carcinoma. J Clin Oncol 17:2896–2900PubMed Wong JH, Severino R, Honnebier MB, Tom P, Namiki TS (1999) Number of nodes examined and staging accuracy in colorectal carcinoma. J Clin Oncol 17:2896–2900PubMed
29.
go back to reference Moriya Y, Hojo K, Sawada T, Koyama Y (1989) Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection. Dis Colon Rectum 32:307–315PubMedCrossRef Moriya Y, Hojo K, Sawada T, Koyama Y (1989) Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection. Dis Colon Rectum 32:307–315PubMedCrossRef
30.
go back to reference Fujita S, Yamamoto S, Akasu T, Moriya Y (2003) Lateral pelvic lymph node dissection for advanced lower rectal cancer. Br J Surg 90:1580–1585PubMedCrossRef Fujita S, Yamamoto S, Akasu T, Moriya Y (2003) Lateral pelvic lymph node dissection for advanced lower rectal cancer. Br J Surg 90:1580–1585PubMedCrossRef
31.
go back to reference Greene FL, Page D, Fleming ID (2002) AJCC Cancer staging manual, 6th edn. Springer, Berlin Heidelberg New York Greene FL, Page D, Fleming ID (2002) AJCC Cancer staging manual, 6th edn. Springer, Berlin Heidelberg New York
32.
go back to reference Enker WE, Thaler HT, Cranor ML, Polyak T (1995) Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 181:335–346PubMed Enker WE, Thaler HT, Cranor ML, Polyak T (1995) Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 181:335–346PubMed
33.
go back to reference (1995) Efficacy of adjuvant fluorouracil and folinic acid in colon cancer. International Multicentre Pooled Analysis of Colon Cancer Trials (IMPACT) Investigators. Lancet 345:939–944 (1995) Efficacy of adjuvant fluorouracil and folinic acid in colon cancer. International Multicentre Pooled Analysis of Colon Cancer Trials (IMPACT) Investigators. Lancet 345:939–944
34.
go back to reference Wolmark N, Rockette H, Fisher B, Wickerham DL, Redmond C, Fisher ER, Jones J, Mamounas EP, Ore L, Petrelli NJ et al (1993) The benefit of leucovorin-modulated fluorouracil as postoperative adjuvant therapy for primary colon cancer: results from National Surgical Adjuvant Breast and Bowel Project protocol C-03. J Clin Oncol 11:1879–1887PubMed Wolmark N, Rockette H, Fisher B, Wickerham DL, Redmond C, Fisher ER, Jones J, Mamounas EP, Ore L, Petrelli NJ et al (1993) The benefit of leucovorin-modulated fluorouracil as postoperative adjuvant therapy for primary colon cancer: results from National Surgical Adjuvant Breast and Bowel Project protocol C-03. J Clin Oncol 11:1879–1887PubMed
Metadata
Title
Isolated tumor cell in lateral lymph node has no influences on the prognosis of rectal cancer patients
Authors
M. Hara
T. Hirai
H. Nakanishi
Y. Kanemitsu
K. Komori
M. Tatematsu
T. Kato
Publication date
01-08-2007
Publisher
Springer-Verlag
Published in
International Journal of Colorectal Disease / Issue 8/2007
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-007-0280-4

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