Does immunostaining effectively upstage colorectal cancer by identifying micrometastatic nodal disease?

Department of Surgery, Medical University of Ohio at Toledo, Toledo, Ohio, United States
International Journal of Colorectal Disease (Impact Factor: 2.45). 02/2007; 22(1):39-48. DOI: 10.1007/s00384-006-0098-5
Source: PubMed


Measure the association between the incidence of primary tumor staining and the identification of mediastinal lymph node (MLN) using cytokeratins, NM23, DCC-positive tumors, and vascular endothelial growth factor (VEGF) expression in T(2) and T(3)/N(0) colorectal cancers. The impact of MLN on both recurrence and survival was assessed.
There were 153 CORC patients (T(2), T(3)/N(0)) selected from a prospectively accrued database. All patients had been staged by routine histopathology after a curative resection and no patients received adjuvant chemotherapy. The primary tumors (PT) were assessed with a panel of immunohistochemical stains (cytokeratin, DCC, Nm23, and VEGF). If the PT was positive, the regional nodes were assessed with that marker(s). For any positive tumor marker, all lymph nodes (LNs, mean of 12.6+/-4.2) were stained for this marker.
Patient age ranged from 38 to 86 years with a mean age of 61.56+/-25.56 years. Mean follow-up was 72.1+/-32.4 months. Recurrence rate of the whole group was 19/153 (12.4%) and the mean time to recurrence was 37.6+/-23.6 months (15 to 77 months). Crude mortality was 39.9%, while the cancer specific mortality was 11.2% after the whole follow-up period. The relationship between PT staining and MLNs was: cytokeratin-PT 143 (93.5%)/MLN 9 (6.3%); NM23-PT 51 (33.3%)/MLN 3 (5.9%); DCC-PT 79 (53%)/MLN 3 (3.8%); and VEGF-PT 72 (47%)/MLN 4 (5.6%). Nineteen (12.4%) patients experienced tumor recurrence. No correlation exist between PT and/or MLN staining and either recurrence or survival. No patient with MLN with any stain experienced a recurrence. There was no advantage to using an individual stain or all four stains.
Immunohistochemical stains for PT and focused analysis of regional nodes did not improve prediction of survival or recurrence. Sentinel LN evaluation and the provision of adjuvant chemotherapy in node-negative patients should be questioned and not be utilized outside of a research protocol.

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    • "Immunostaining present in the cytoplasm of the malignant cells was regarded as positive for MMP-7 and VEGF protein expression. The scoring of the tissue sections was based on the percentage of the stained tumor cells [24]. The expression of STAT3, pSTAT3, MMP-7 and VEGF was based on the percentage of malignant cells stained: 0% -10% as negative; 11% -25% as weakly positive, and equal or more than 26% as strongly positive or overexpressed. "

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    ABSTRACT: The colorectal cancer is responsible for 8.000 deaths a year in Brazil. It is believed that there is post operative sub staged. The objective of this study is to research on the sentinel lymph node in patients with colon cancer. The sample was composed by 18 patients, all of them with diagnose of cancer, undertaken to laparotomy with injection of the markers of lymph nodes in the subserosa peritumoral. RESULTS: intraoperative identification sentinel lymph nodes with the markers occurred in 16 (88,8%) patients. The patent blue dye identified sentinel lymph nodes in 13 (72,2%) and the radioisotopic in 16 (88,8%). Lymphoscintigraphy of surgical specimen were obtained from 15 patients. The global sensitivity of this method was of 66,7% and the false-negative of 33,3%. After the histological examination with multilevel section and immunohistochemical in 11 patients, one (9%) case of micrometastase was diagnosed being consideredultrastaging. CONCLUSIONS: It can be said that the procedure is viable; the radioisotope is more effective; the lymphoscintigraphy of the surgical specimen is capable of certifying the presence of absorption of the radioisotope by the lymph node; the incidence of lymph node metastases is,proportionally, the same as the one of the sentinel and non sentinel nodes; the techniques of the multilevel section and immunohistochemical contribute to improve the activity of the lymph node metastases diagnose.
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