Impact of macroscopic enlarged lymph node on stage colorectal cancer prognosis and its potential mechanism
10.3760/cma.j.issn.1671-0274.2015.06.011
- VernacularTitle:肉眼观肿大淋巴结对Ⅱ期结直肠癌预后的影响及其机制探讨
- Author:
Wenhua FAN
1
;
Ziyi HUANG
;
Yujing FANG
;
Desen WAN
;
Zhizhong PAN
;
Liren LI
Author Information
1. 中山大学肿瘤防治中心结直肠外科
- Keywords:
Colorectal neoplasms,stage Ⅱ;
Macroscopical lymph node;
Micrometastasis;
Prognosis
- From:
Chinese Journal of Gastrointestinal Surgery
2015;(6):558-562
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the impact of macroscopic enlarged lymph node on the clinicopathological characteristics of stage Ⅱ colorectal cancer, and to explore the potential mechanism. Methods Clinicopathological data of 116 consecutive patients with stage Ⅱ colorectal cancer, who underwent colorectal radical resection and were identified as stage Ⅱ colorectal cancer without mesenteric metastasis by postoperative pathology , in our department between December 2001 and December 2002 were analyzed retrospectively. All the patients were examined by the surgeons with gross appearance to decide the enlarged lymph nodes as metastasis during operation. There were 43 patients with macroscopic enlarged lymph nodes and 73 without such lymph nodes. Survival rate was compared between the two groups. Impact of macroscopic enlarged lymph node on the prognosis of stage Ⅱcolorectal cancer was analyzed. Structure of macroscopic enlarged lymph node was observed. CK expression in 107 macroscopic enlarged lymph nodes from 43 cases was examined by immunohistochemistry. Results The 10-year disease-free survival(DFS) of the whole group was 83.5%. The 10-year DFS of patients with macroscopic enlarged lymph nodes was 75.9% , which was significantly lower than 89.3%(P=0.038) of patients without macroscopic enlarged lymph nodes. Univariate analysis showed that macroscopical enlarged lymph node (P=0.038), perioperative blood transfusion (P=0.004), number of retrieved lymph nodes (P=0.016), concomitant disease (P=0.003), and preoperative serum carcinoembryonic antigen (CEA) level (P=0.050) were related to the prognosis of all the 116 patients. Multivariate analysis showed that macroscopical enlarged lymph node (P=0.044), number of retrieved lymph nodes (P=0.021), and perioperative blood transfusion (P=0.032) were independent prognostic factors. Haematoxylin and eosin (HE) staining indicated that enlarged lymph nodes had hyperplasia reaction. Immunohistochemistry showed that among 107 enlarged lymph nodes, 1 had macrometastases, 1 micrometastasis, 4 isolated tumor cell (ITC), and the rest 101 had no positive CK expression. Conclusion Macroscopic enlarged lymph node indicates a poor prognosis in patients with stage Ⅱ colorectal cancer.
