Surgery
Volume 147, Issue 3 , Pages 352-357, March 2010

Predictors of occult nodal metastasis in colon cancer: Results from a prospective multicenter trial

Presented in part at the Pacific Coast Surgical Association Meeting, San Diego, CA, February 16, 2008.

  • Nabil Wasif, MD

      Affiliations

    • John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA
    • ,
  • Mark B. Faries, MD

      Affiliations

    • John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA
    • ,
  • Sukamal Saha, MD, FACS

      Affiliations

    • Michigan State University McLaren Regional Medical Center, Flint, MI
    • ,
  • Roderick R. Turner, MD

      Affiliations

    • John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA
    • ,
  • David Wiese, MD

      Affiliations

    • Michigan State University McLaren Regional Medical Center, Flint, MI
    • ,
  • Martin D. McCarter, MD, FACS

      Affiliations

    • Department of Surgery, Division of GI Tumors and Endocrine Surgery, University of Colorado at Denver and Health Sciences Center, Denver, CO
    • ,
  • Perry Shen, MD, FACS

      Affiliations

    • Department of Surgical Oncology, Wake Forest University Medical Center, Winston-Salem, NC
    • ,
  • Alexander Stojadinovic, MD, FACS

      Affiliations

    • United States Military Cancer Institute, Walter Reed Army Medical Center, Washington, DC
    • ,
  • Anton J. Bilchik, MD, PhD, FACS

      Affiliations

    • David Geffen School of Medicine, University of California at Los Angeles, and California Oncology Research Institute, Santa Monica, CA
    • Corresponding Author InformationReprinted requests: Anton J. Bilchik, MD, PhD, FACS, David Geffen School of Medicine, University of California at Los Angeles, 2336 Santa Monica Boulevard, Suite 206, Santa Monica, CA 90404.

Accepted 2 October 2009. published online 01 February 2010.

Background

The relationship between primary colon cancer and occult nodal metastases (OMs) detected by cytokeratin immunohistochemistry (CK-IHC) is unknown. We sought to investigate the correlation of clinicopathologic features of colon cancer with OMs and to identify predictors of OM.

Methods

Patients with colon cancer from 5 tertiary referral cancer centers enrolled in a prospective trial of staging had standard pathologic analysis performed on all resected lymph nodes (using hematoxylin and eosin staining [H&E]). Nodes negative on H&E underwent CK-IHC to detect OMs, which were defined as micrometastases (N1mic) or isolated tumor cells (N0i+). Patients who were negative on both H&E and CK-IHC were defined as node negative (NN), and those positive on H&E were node positive (NP). The relationships between tumor characteristics and OMs were analyzed using the Kruskal-Wallis and the Fisher exact test.

Results

OMs were identified in 23.4% (25/107) of patients. No significant differences were found in demographics, tumor location, tumor size, and number of nodes examined between groups. Compared with the NN group, patients with OMs had more tumors that were T3/T4 (72% vs 57%; P < .001), had tumors of higher grade (28% vs 12%; P = .022), and had tumors with lymphovascular invasion (16% vs 3%; P < .001).

Conclusion

Adverse primary pathologic colon cancer characteristics correlate with OMs. In patients with negative nodes on H&E and stage T3/T4 colon cancer, lymphovascular invasion, or high tumor grade, consideration should be given to performing CK-IHC. The detection of OMs in this subset may influence decisions regarding adjuvant chemotherapy and risk stratification.

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 Supported by Grant 2RO1CA090848-05A2 from the National Cancer Institute and by funding from the William Randolph Hearst Foundation (San Francisco, CA), The Joyce E. and Ben B. Eisenberg Foundation (Los Angeles, CA), Davidow Charitable Fund (Los Angeles, CA), the Sequouia Foundation, Mrs. Ruth Weil (Los Angeles, CA), the Rod Fasone Memorial Cancer Fund (Los Angeles, CA), and the Henry L. Guenther Foundation (Los Angeles, CA).

PII: S0039-6060(09)00618-7

doi:10.1016/j.surg.2009.10.008

Surgery
Volume 147, Issue 3 , Pages 352-357, March 2010

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