ORIGINAL ARTICLE

High prevalence of isolated tumour cells in regional lymph nodes from pN0 colorectal cancer

C Mescoli¹, M Rugge¹, S Pucciarelli², V M Russo³, G Pennelli¹, M Guido¹ and D Nitti²

¹ Department of Diagnostic Sciences & Special Therapies (Pathology Unit), Istituto Oncologico Veneto (IOV)—IRCCS, Università degli Studi di Padova, Padova, Italy
² Department of Oncological & Surgical Sciences (Surgery Unit), Università degli Studi di Padova
³ Department of Pathology, S Luigi Hospital Catania, Catania, Italy

Correspondence to:
Correspondence to:
M Rugge
Cattedra di Anatomia Patologica, Istituto Oncologico Veneto-IRCCS, Università degli Studi di Padova, Via Aristide Gabelli, 61, 35121– Padova, Italy; massimo.rugge@.unipd.it

Background: The prevalence of isolated tumour cells (ITCs) in regional lymph nodes from colorectal cancer (CRC) is controversial and has never been prospectively assessed in large groups of consecutive patients. pN0 early-relapsing CRC can be explained by lymph node-ITC.

Aim: : To assess the prevalence of ITCs in regional lymph nodes from 309 consecutive patients with pN0M0 (pathological (p)-tumour-node-metastasis (TNM) staging system) CRCs.

Patients and methods: ITCs were assessed by immunohistochemistry (MNF116 monoclonal antibody (1:100); Dako, Glostrup, Denmark) in two serial histological sections obtained from 5016 mesenteric lymph nodes from 309 patients with pN0 CRCs (mean number of lymph nodes per patient = 16.2; p-TNM stage 0, n = 25; p-TNM stage I, n = 123; and p-TNM stage II (A+B), n = 161). Tumour histology, vascular cancer invasion and pathological stage were also recorded.

Results: ITCs were detected in the regional lymph nodes of 156 of 309 (50.5%) patients with CRC, mostly in nodes located within 3 cm from the neoplasia. ITC status correlated with (a) tumour p-TNM stage (Pearson’s ²: p<0; ordered logistic regression: odds ratio (OR) = 4.6; 95% confidence interval (CI) = 2.88 to 7.33; p<0) and (b) pT value (Pearson’s ²: p = 0; ordered logistic regression: OR = 4.9; 95% CI = 3.1 to 7.7; p<0). By multivariate analysis, including p-TNM stage, vascular invasion and ITC status, both stage (OR = 5.1; 95% CI = 2.9 to 8.9; p<0) and vascular invasion (OR = 4.2; 95% CI = 1.94 to 8.98; p<0) were found to be independent variables associated with ITC+ lymph nodes.

Conclusion: More than 50% of pN0-CRC patients have ITCs in the mesenteric lymph nodes. ITC status is significantly correlated with cancer stage and vascular cancer invasion. The clinicopathological effect of ITC remains to be prospectively evaluated.

Abbreviations: CRC, colorectal cancer; IHC, immunohistochemistry; ITCs, isolated tumour cells; p-TNM, pathological tumour-node-metastasis

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