Welche Standards braucht die Lymphknoten-Histologie beim kolorektalen Karzinom?

Zusammenfassung

Das therapeutische Management des kolorektalen Karzinoms hängt entscheidend vom histologisch evaluierten Lymphknotenstatus ab. Erkenntnisse neuerer Studien weisen darauf hin, dass anstelle einer geforderten Minimalanzahl von zwölf Lymphknoten, die Präparation und histologische Untersuchung aller Lymphknoten eines Operationspräparates anzustreben ist. Dabei ist auch zu beachten, dass, trotz sachgemäßer Aufarbeitung durch den Pathologen, auch Fälle (insbesondere beim Rektumkarzinom) mit deutlich weniger als zwölf Lymphknoten vorkommen können.

Abstract

The detection of lymph node metastases is of vital importance for the therapeutical decision-making in patients with colorectal carcinoma. Due to the results of several recently published studies it seems to be most desirable to identify all lymph nodes rather than follow the recommendation to investigate a minimum number of twelve lymph nodes. However, it has to be noted that, despite a scrupulously exact lymph node recovery by the pathologist, in some cases (particularly in rectal carcinoma) substantially less than twelve lymph nodes may be yielded.

kolorektales Karzinom - Lymphknoten - Lymphknotenausbeute - Minimalanzahl - Sentinel-Lymphknoten

colorectal carcinoma - lymph node - lymph node recovery - minimum number - sentinel lymph node

Literatur

• 1 Moertel C G, Fleming T R, MacDonald J S. et al . Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma.  N Engl J Med. 1990;  322 352-358
• 2 Marsoni S. Fluorouracil and folinic acid in colon cancer. IMPACT Investigators.  Lancet. 1995;  345 1582-1583
• 3 Hermanek P. [Oncologic suergery/pathologic-anatomic viewpoint]. Langenbecks Arch Chir Suppl Kongressbd 1991; 277-281
• 4 Sobin L H, Wittekind C. TNM Classification of Malignant Tumours. 5th Edition. Wiley-Liss, New York, Chichester, Weinheim, Brisbane, Singapore, Toronto 1997; 66-69
• 5 Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, Miedema B, Ota D, Sargent D. National Cancer Institute Expert Panel . Guidelines 2000 for colon and rectal cancer surgery.  J Natl Cancer Inst. 2001;  93 583-596
• 6 Goldstein N S. Lymph node recoveries from 2 427 pT3 colorectal resection specimens spanning 45 years: recommendations for a minimum number of recovered lymph nodes based on predictive probabilities.  Am J Surg Pathol. 2002;  26 179-189
• 7 Thorn C C, Woodcock N P, Scott N. et al . What factors affect lymph node yield in surgery for rectal cancer?.  Colorectal Dis. 2004;  6 356-361
• 8 Sobin L H, Wittekind C. TNM Classification of Malignant Tumours. 6th Edition. Wiley-Liss, New York 2002; 72-76
• 9 Wittekind C, Greene F L, Henson D E, Hutter R VP, Sobin L H. TNM Supplement. A Commentary on Uniform Use. Wylie-Liss, New York 2003; 41-43
• 10 Goldstein N S, Turner J R. Pericolonic tumour deposits in patients with T3N+M0 colon adenocarcinomas: a marker for reduced disease-free survival and intraabdominal metastasis.  Cancer. 2000;  88 2228-2238
• 11 Harrison J C, Dean P J, El-Zeky F, Vander Zwaag R. From Dukes through Jass. Pathological prognostic indicators in rectal carcinoma.  Hum Pathol. 1994;  25 498-505
• 12 Harrison J C, Dean P J, El-Zeky F, Vander Zwaag R. Impact of the Crohn's like lymphoid reaction on staging of right-sided colon cancer. Results of a multivariate analysis.  Hum Pathol. 1995;  26 31-38
• 13 Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften .AWMF online.  www.uni-duesseldorf.de/WWW/AWMF/ll/index.html
• 14 Scott N, Jackson P, al-Jaberi T. et al . Total mesorectal excision and local recurrence: a study of tumour spread in the mesorectum distal to rectal cancer.  Br J Surg. 1995;  82 1031-1033
• 15 Heald R J, Husband E M, Ryall R D. The mesorectum in rectal cancer surgery - the clue to pelvic recurrence?.  Br J Surg. 1982;  69 613-616
• 16 Wiggers T, Jeekel J, Arends J W. et al . No-touch isolation technique in colon cancer: a controlled prospective trial.  Br J Surg. 1988;  75 409-415
• 17 Rouffet F, Hay J M, Vacher B. et al., French Association for Surgical Research . Curative resection for left colonic carcinoma: hemicolectomy vs. segmental colectomy. A prospective, controlled, multicenter trial.  Dis Colon Rectum. 1994;  37 651-659
• 18 Martling A, Holm T, Rutqvist L E, Johansson H, Moran B J, Heald R J, Cedermark B. Impact of a surgical training programme on rectal cancer outcomes in Stockholm.  Br J Surg. 2005;  92 225-229
• 19 Matzel K E, Merkel S, Hohenberger W. Lokale Therapieprinzipien beim Rektumkarzinom.  Chirurg. 2003;  74 897-904
• 20 Zirngibl H, Husemann B, Hermanek P. Intraoperative spillage of tumor cells in surgery for rectal cancer.  Dis Colon Rectum. 1990;  33 610-614
• 21 Clinical Outcomes of Surgical Therapy Study Group . A comparison of laparoscopically assisted and open colectomy for colon cancer.  N Engl J Med. 2004;  350 2050-2059
• 22 Guillou P J, Quirke P, Thorpe H. et al. nd the MRC CLASICC trial group . Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial.  Lancet. 2005;  365 1718-1726
• 23 Caplin S, Cerottini J P, Bosman F T, Constanda M T, Givel J C. For patients with Dukes' B (TNM Stage II) colorectal carcinoma, examination of six or fewer lymph nodes is related to poor prognosis.  Cancer. 1998;  83 666-672
• 24 Cianchi F, Palomba A, Boddi V. et al . Lymph node recovery from colorectal tumor specimens: recommendation for a minimum number of lymph nodes to be examined.  World J Surg. 2002;  26 384-389
• 25 Tepper J E, O'Connell M J, Niedzwiecki D. et al . Impact of number of nodes retrieved on outcome in patients with rectal cancer.  J Clin Oncol. 2001;  19 157-163
• 26 Pocard M, Panis Y, Malassagne B, Nemeth J, Hautefeuille P, Valleur P. Assessing the effectiveness of mesorectal excision in rectal cancer: prognostic value of the number of lymph nodes found in resected specimens.  Dis Colon Rectum. 1998;  41 839-845
• 27 Jass J R. Prognostic factors in rectal cancer.  Eur J Cancer. 1995;  31A 862-863
• 28 Newland R C, Chapuis P H, Smyth E J. The prognostic value of substaging colorectal carcinoma. A prospective study of 1 117 cases with standardized pathology.  Cancer. 1987;  60 852-857
• 29 Cohen A M, Minsky B D, Schilsky R L. Cancers of the gastrointestinal tract: cancer iof the colon. In: DeVita Jr VT, Hellman S, Rosenberg SA (eds). Cancer Principles and Practice of Oncology. Lippincott-Raven, Philadelphia 1997; 1144-1196
• 30 Jass J R, Morson B C. Reporting colorectal cancer.  J Clin Pathol. 1987;  40 1016-1023
• 31 Cohen A M, Tremiterra S, Candela F, Thaler H T, Sigurdson E R. Prognosis of node-positive colon cancer.  Cancer. 1991;  67 1859-1861
• 32 Hida J, Mori N, Kubo R. et al . Metastases from carcinoma of the colon and rectum detected in small lymph nodes by the clearing method.  J Am Coll Surg. 1994;  178 223-228
• 33 Bognel C, Rekacewicz C, Mankarios H. et al . Prognostic value of neural invasion in rectal carcinoma: a multivariate analysis on 339 patients with curative resection.  Eur J Cancer. 1995;  31A 894-898
• 34 Moran M R, James E C, Rothenberger D A, Goldberg S M. Prognostic value of positive lymph nodes in rectal cancer.  Dis Colon Rectum. 1992;  35 579-581
• 35 Macdonald J S. Adjuvant therapy of colon cancer.  CA Cancer J Clin. 1999;  49 202-219
• 36 Allegra C J, Paik S, Colangelo L H. et al . Prognostic value of thymidylate synthase, Ki-67, and p53 in patients with Dukes' B and C colon cancer: a National Cancer Institute-National Surgical Adjuvant Breast and Bowel Project collaborative study.  J Clin Oncol. 2003;  21 241-250
• 37 Figueredo A, Charette M L, Maroun J, Brouwers M C, Zuraw L. Adjuvant therapy for stage II colon cancer: a systematic review from the Cancer Care Ontario Program in evidence-based care's gastrointestinal cancer disease site group.  J Clin Oncol. 2004;  22 3395-3407
• 38 O'Connell M J, Schaid D J, Ganju V, Cunningham J, Kovach J S, Thibodeau S N. Current status of adjuvant chemotherapy for colorectal cancer. Can molecular markers play a role in predicting prognosis?.  Cancer. 1992;  70 1732-1739
• 39 Frey U H, Alakus H, Wohlschläger J. et al . GNAS1 T393C polymorphism and survival in patients with sporadic colorectal cancer.  Clin Cancer Res. 2005;  11 5071-5077
• 40 Mulsow J, Winter D C, O'Keane J C, O'Connell P R. Sentinel lymph node mapping in colorectal cancer.  Br J Surg. 2003;  90 659
• 41 Bertagnolli M, Miedema B, Redston M. et al . Sentinel node staging of resectable colon cancer: results of a multicenter study.  Ann Surg. 2004;  240 624-628
• 42 Patten L C, Berger D H, Rodriguez-Bigas M. et al . A prospective evaluation of radiocolloid and immunohistochemical staining in colon carcinoma lymphatic mapping.  Cancer. 2004;  100 2104-2109
• 43 Stojadinovic A, Allen P J, Protic M, Potter J F, Shriver C D, Nelson J M, Peoples G E. Colon sentinel lymph node mapping: practical surgical applications.  J Am Coll Surg.. 2005;  201 297-313