The prognostic value of micrometastases and isolated tumour cells in histologically negative lymph nodes of patients with colorectal cancer: a systematic review and meta-analysis

D A M Sloothaak; S Sahami; H J van der Zaag-Loonen; E S van der Zaag; P J Tanis; W A Bemelman; C J Buskens

doi:10.1016/j.ejso.2013.12.002

The prognostic value of micrometastases and isolated tumour cells in histologically negative lymph nodes of patients with colorectal cancer: a systematic review and meta-analysis

Eur J Surg Oncol. 2014 Mar;40(3):263-9. doi: 10.1016/j.ejso.2013.12.002. Epub 2013 Dec 14.

Authors

D A M Sloothaak¹, S Sahami², H J van der Zaag-Loonen³, E S van der Zaag⁴, P J Tanis², W A Bemelman², C J Buskens⁵

Affiliations

¹ Department of Surgery, Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands; Department of Surgery, AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
² Department of Surgery, AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
³ Department of Epidemiology, Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands.
⁴ Department of Surgery, Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands.
⁵ Department of Surgery, AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: c.j.buskens@amc.uva.nl.

PMID: 24368050
DOI: 10.1016/j.ejso.2013.12.002

Abstract

Introduction: Detection of occult tumour cells in lymph nodes of patients with stage I/II colorectal cancer is associated with decreased survival. However, according to recent guidelines, occult tumour cells should be categorised in micrometastases (MMs) and isolated tumour cells (ITCs). This meta-analysis evaluates the prognostic value of MMs and of ITCs, separately.

Methods: PubMed, Embase, Biosis and the World Health Organization International Trials Registry Platform were searched for papers published until April 2013. Studies on the prognostic value of MMs and ITCs in lymph nodes of stage I/II colorectal cancer patients were included. Odds ratios (ORs) for the development of disease recurrence were calculated to analyse the predictive value of MMs and ITCs.

Results: From five papers, ORs for disease recurrence could be calculated for MMs and ITCs separately. In patients with colorectal cancer, disease recurrence was significantly increased in the presence of MMs in comparison with absent occult tumour cells (OR 5.63; 95%CI 2.4-13.13). This was even more pronounced in patients with colon cancer (OR 7.25 95% CI 1.82-28.97). In contrast, disease recurrence was not increased in the presence of ITCs (OR 1.00 95% CI 0.53-1.88).

Conclusion: Patients with stage I/II colorectal cancer and MMs have a worse prognosis than patients without occult tumour cells. However, ITCs do not have a predictive value. The distinction between ITCs and MMs should be made if the detection of occult tumour cells is incorporated in the clinical decision for adjuvant treatment.

Keywords: Colorectal neoplasm; Lymph nodes; Occult tumour cells; Staging.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Adenocarcinoma / mortality
Adenocarcinoma / secondary*
Adenocarcinoma / therapy
Aged
Biopsy, Needle
Colorectal Neoplasms / mortality
Colorectal Neoplasms / pathology*
Colorectal Neoplasms / therapy
Confidence Intervals
Evaluation Studies as Topic
Female
Humans
Immunohistochemistry
Lymph Nodes / pathology*
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Invasiveness / pathology
Neoplasm Micrometastasis / diagnosis
Neoplasm Micrometastasis / pathology*
Neoplasm Recurrence, Local / pathology
Neoplasm Recurrence, Local / prevention & control
Neoplasm Staging
Neoplastic Cells, Circulating / pathology*
Odds Ratio
Prognosis
Risk Assessment
Survival Analysis