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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Article info
Publication history
Published online: February 01, 2010
Accepted:
October 2,
2009
Footnotes
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).
Identification
Copyright
© 2010 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
