Excellent prognosis of node negative patients after sentinel node procedure in colon carcinoma: a 5-year follow-up study

Eur J Surg Oncol. 2014 Jun;40(6):747-55. doi: 10.1016/j.ejso.2013.10.003. Epub 2013 Oct 23.

Abstract

Aim: Investigate the prognostic impact and clinical relevance of the sentinel node (SN)-procedure in colon carcinoma.

Patients and methods: Between May 2002 and January 2004, the SN-procedure was performed in 55 patients that underwent elective resection for clinically non-advanced colon carcinoma. A control group of 110 patients was identified from a cohort between January 2000 and April 2002. All lymph nodes were analysed by conventional haematoxylin-eosin staining. All negative SNs underwent in-depth analysis using immunohistochemical-staining and automated microscopy with the Ariol-system. Patients with positive lymph nodes were offered adjuvant chemotherapy. All patients were routinely monitored at 6-month intervals and follow-up was more than 5 years.

Results: The SN was successfully identified in 98% of the patients, with 94% sensitivity. In-depth analysis with immunohistochemistry and automated microscopy (Ariol-system) upstaged 3 and 4 patients respectively. When only node-negative patients were analysed, overall 5-year-survival was significantly better in the SN group (91% vs. 76%, p = 0.04). Cancer-specific-mortality was even 0% (vs. 8%, p = 0.08). Disease-free-survival was significantly improved to 96% (vs. 77%, p < 0.01).

Conclusions: This study describes the prognostic impact of the SN-procedure in colon carcinoma after 5-year-follow-up. Only one patient had recurrent disease after a negative SN procedure (disease-free-survival 96%). These results indicate that the SN-procedure is of prognostic relevance and might be useful to select patients for adjuvant chemotherapy. Patients that are lymph node negative after an SN-procedure have an excellent prognosis and do not need adjuvant treatment.

Keywords: Colonic neoplasms; Colorectal neoplasms; Follow-up studies; Lymphatic metastasis; Neoplasm staging; Sentinel lymph node biopsy.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Chemotherapy, Adjuvant
  • Colonic Neoplasms / drug therapy
  • Colonic Neoplasms / pathology*
  • Colonic Neoplasms / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Immunohistochemistry
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Prognosis
  • Sensitivity and Specificity
  • Sentinel Lymph Node Biopsy*
  • Survival Rate