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Open Access 01-12-2010 | Colorectal Cancer

Lymph Node Negative Colorectal Cancers with Isolated Tumor Deposits Should Be Classified and Treated As Stage III

Authors: E. J. Th. Belt, MD, M. F. M. van Stijn, MD, H. Bril, MD, PhD, E. S. M. de Lange-de Klerk, MD, PhD, G. A. Meijer, MD, PhD, S. Meijer, MD, PhD, H. B. A. C. Stockmann, MD, PhD

Published in: Annals of Surgical Oncology | Issue 12/2010

Abstract

Background

The prognostic role of pericolic or perirectal isolated tumor deposits (ITDs) in node-negative colorectal cancer (CRC) patients is unclear. Rules to define ITDs as regional lymph node metastases changed in subsequent editions of the TNM staging without substantial evidence. Aim of this study was to investigate the correlation between ITDs and disease recurrence in stage II and III CRC patients.

Materials and Methods

The medical files of 870 CRC patients were reviewed. Number, size, shape, and location pattern of all ITDs in node-negative patients were examined in relation to involvement of vascular structures and nerves. The correlation between ITDs and the development of recurrent disease was investigated.

Results

Disease recurrence was observed in 50.0% of stage II patients with ITDs (13 of 26), compared with 24.4% of stage II patients without ITDs (66 of 270) (P < .01). Disease-free survival of ITD-positive stage II patients was comparable with that of stage III patients. Also within stage III, more recurrences were observed in ITD-positive patients compared with ITD-negative patients (65.1 vs. 39.1%, respectively). No correlation was found between size of ITDs and disease recurrence. More recurrences were seen in patients with irregularly shaped ITDs compared with patients with 1 or more smooth ITDs present.

Conclusions

Because of the high risk of disease recurrence, all node-negative stage II patients with ITDs, regardless of size and shape, should be classified as stage III, for whom adjuvant chemotherapy should be considered.

World Health Organization. http://www.who.int/mediacentre/factsheets/fs297/en/. (February 2009).

American Joint Committee on Cancer. Manual for staging of cancer. Philadelphia: Lippincott-Raven; 1998.

Hermanek P, Sobin LH, International Union Against Cancer (UICC). TNM classification of malignant tumours. 4th ed. New York: Springer-Verlag; 1987.

Sobin LH, Wittekind CH. International Union Against Cancer (UICC). TNM classification of malignant tumours. 5th ed. New York: Wiley-Liss Publications; 1997.

Nagtegaal ID, Quirke P. Colorectal tumour deposits in the mesorectum and pericolon; a critical review. Histopathology. 2007;51:141–9.CrossRefPubMed

Sobin LH, Wittekind CH, International Union Against Cancer (UICC). TNM classification of malignant tumours. 6th ed. New York: Wiley-Liss Publications; 2002.

Morris EJ, Maughan NJ, Forman D, Quirke P. Who to treat with adjuvant therapy in Dukes B/stage II colorectal cancer? The need for high quality pathology. Gut. 2007;56:1419–25.CrossRefPubMed

Gabriel WB, Dukes CE, Bussey HJR. Lymphatic spread in cancer of the rectum. Br J Surg. 1935;23:395–413.CrossRef

Prabhudesai A, Arif S, Finlayson CJ, Kumar D. Impact of microscopic extranodal tumor deposits on the outcome of patients with rectal cancer. Dis Colon Rectum. 2003;46:1531–7.CrossRefPubMed

10.

Ueno H, Mochizuki H. Clinical significance of extrabowel skipped cancer infiltration in rectal cancer. Surg Today. 1997;27:617–22.CrossRefPubMed

11.

Ueno H, Mochizuki H, Tamakuma S. Prognostic significance of extranodal microscopic foci discontinuous with primary lesion in rectal cancer. Dis Colon Rectum. 1998;41:55–61.CrossRefPubMed

12.

Harrison JC, Dean PJ, el Zeky F, Vander Zwaag R. From Dukes through Jass: pathological prognostic indicators in rectal cancer. Hum Pathol. 1994;25:498–505.CrossRefPubMed

13.

Harrison JC, Dean PJ, el Zeky F, Vander Zwaag R. Impact of the Crohn’s-like lymphoid reaction on staging of right-sided colon cancer: results of multivariate analysis. Hum Pathol. 1995;26:31–8.CrossRefPubMed

14.

Ratto C, Ricci R, Rossi C, Morelli U, Vecchio FM, Doglietto GB. Mesorectal microfoci adversely affect the prognosis of patients with rectal cancer. Dis Colon Rectum. 2002;45:733–42.CrossRefPubMed

15.

Balch CM, Buzaid AC, Soong SJ, Atkins MB, Cascinelli N, Coit DG, et al. Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol. 2001;19:3635–48.PubMed

16.

Goldstein NS, Turner JR. Pericolonic tumor deposits in patients with T3N+MO colon adenocarcinomas: markers of reduced disease free survival and intra-abdominal metastases and their implications for TNM classification. Cancer. 2000;88:2228–38.CrossRefPubMed

17.

Tocchi A, Mazzoni G, Lepre L, Liotta G, Costa G, Agostini N, et al. Total mesorectal excision and low rectal anastomosis for the treatment of rectal cancer and prevention of pelvic recurrences. Arch Surg. 2001;136:216–20.CrossRefPubMed

18.

Tateishi S, Arima S, Futami K, Kawahara K, Tachikawa D, Naritomi K, et al. A clinicopathological investigation of “tumor nodules” in colorectal cancer. Surg Today. 2005;35:377–84.CrossRefPubMed

Title: Lymph Node Negative Colorectal Cancers with Isolated Tumor Deposits Should Be Classified and Treated As Stage III
Authors: E. J. Th. Belt, MD
M. F. M. van Stijn, MD
H. Bril, MD, PhD
E. S. M. de Lange-de Klerk, MD, PhD
G. A. Meijer, MD, PhD
S. Meijer, MD, PhD
H. B. A. C. Stockmann, MD, PhD
Publication date: 01-12-2010
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 12/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-010-1152-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Lymph Node Negative Colorectal Cancers with Isolated Tumor Deposits Should Be Classified and Treated As Stage III

Abstract

Background

Materials and Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Materials and Methods

Results

Conclusions

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