Institute of Pathology, Klinikum Augsburg, Augsburg, Germany.
Mod Pathol. 2012 Oct;25(10):1413-22. doi: 10.1038/modpathol.2012.92. Epub 2012 Jun 8.
To date, the clinical value of lymph node size in colon cancer has been investigated only in a few studies. Only in radiological diagnosis is lymph node size routinely recognized, and nodes ≥10 mm in diameter are considered pathologic. However, the few studies regarding this topic suggest that lymph node size is not a reliable indicator of metastatic disease. Moreover, we hypothesized that increasing lymph node size is associated with favorable outcome. By performing a morphometric study, we investigated the clinical significance of lymph node size in colon cancer in terms of metastatic disease and prognosis. A cohort of 237 cases with excellent lymph node harvest (mean lymph node count: 33±17) was used. The size distribution in node-positive and -negative cases was almost identical. In all, 151 out of the 305 metastases detected (49.5%) were found in lymph nodes with diameters ≤5 mm. Only 25% of lymph nodes >10 mm showed metastases. Minute lymph nodes ≤1 mm were involved only very rarely (2 of 81 cases). In 67% of the cases, the largest positive lymph node was <10 mm. The prognostic relevance of lymph node size was investigated in a subset of 115 stage I/II cases. The occurrence of ≥7 lymph nodes that were >5 mm in diameter was significantly associated with better overall survival. Our data show that lymph node size is not a suitable factor for preoperative lymph node staging. Minute lymph nodes have virtually no role in correct histopathological lymph node staging. Finally, large lymph nodes in stage I/II disease might indicate a favorable outcome.
迄今为止，只有少数研究探讨了结肠癌中淋巴结大小的临床价值。只有在放射诊断中，淋巴结大小才被常规识别，直径≥10 毫米的淋巴结被认为是病理性的。然而，关于这一主题的少数研究表明，淋巴结大小不是转移性疾病的可靠指标。此外，我们假设淋巴结大小的增加与良好的预后相关。通过进行形态计量学研究，我们调查了淋巴结大小在结肠癌中对转移性疾病和预后的临床意义。使用了一个具有良好淋巴结收获的 237 例病例队列（平均淋巴结计数：33±17）。在淋巴结阳性和阴性病例中，淋巴结大小的分布几乎相同。在总共检测到的 305 个转移灶中，有 151 个（49.5%）位于直径≤5 毫米的淋巴结中。只有 25%的>10 毫米的淋巴结有转移。直径≤1 毫米的微小淋巴结很少受累（81 例中有 2 例）。在 67%的病例中，最大的阳性淋巴结直径<10 毫米。在 115 例 I/II 期病例的亚组中，研究了淋巴结大小的预后相关性。≥7 个直径>5 毫米的淋巴结的存在与总生存率的显著提高显著相关。我们的数据表明，淋巴结大小不是术前淋巴结分期的合适因素。微小淋巴结在正确的组织病理学淋巴结分期中几乎没有作用。最后，I/II 期疾病中的大淋巴结可能表明预后良好。
