Liefers G J, Cleton-Jansen A M, van de Velde C J, Hermans J, van Krieken J H, Cornelisse C J, Tollenaar R A
Department of Surgery, Leiden University Medical Center, The Netherlands.
N Engl J Med. 1998 Jul 23;339(4):223-8. doi: 10.1056/NEJM199807233390403.
Standard treatment of colorectal cancer includes adjuvant chemotherapy for patients with stage III disease (defined by the presence of lymph-node metastases), but not for patients with stage II tumors (who have no lymph-node metastases). However, 20 percent of patients with stage II tumors die of recurrent disease. We investigated whether the detection of micrometastases can be used to identify patients with stage II disease who are at high risk for recurrence.
We analyzed 192 lymph nodes from 26 consecutive patients with stage II colorectal cancer, using a carcinoembryonic antigen-specific nested reverse-transcriptase polymerase chain reaction. Five-year follow-up information was obtained on all patients. Observed and adjusted survival rates were assessed in the patients with and the patients without micrometastases.
Micrometastases were detected in one or more lymph nodes from 14 of 26 patients (54 percent). The adjusted five-year survival rate (for which only cancer-related deaths were considered) was 50 percent in this group, whereas in the 12 patients without micrometastases, the survival rate was 91 percent (P=0.02 by the log-rank test). The observed five-year survival rates were 36 percent and 75 percent, respectively (P=0.03). The groups were similar with respect to age, sex, tumor side (location in relation to the flexura lienalis), degree of tumor differentiation (grade), and diameter of the primary tumor.
Molecular detection of micrometastases is a prognostic tool in stage II colorectal cancer.
结直肠癌的标准治疗包括对Ⅲ期疾病患者（定义为存在淋巴结转移）进行辅助化疗，但对Ⅱ期肿瘤患者（无淋巴结转移）则不进行。然而，20%的Ⅱ期肿瘤患者死于复发性疾病。我们研究了微转移的检测是否可用于识别Ⅱ期疾病中复发风险高的患者。
我们使用癌胚抗原特异性巢式逆转录聚合酶链反应分析了26例连续的Ⅱ期结直肠癌患者的192个淋巴结。获得了所有患者的五年随访信息。对有微转移和无微转移的患者评估观察到的和调整后的生存率。
26例患者中有14例（54%）在一个或多个淋巴结中检测到微转移。该组调整后的五年生存率（仅考虑与癌症相关的死亡）为50%，而在12例无微转移的患者中，生存率为91%（对数秩检验P=0.02）。观察到的五年生存率分别为36%和75%（P=0.03）。两组在年龄、性别、肿瘤部位（相对于脾曲的位置）、肿瘤分化程度（分级）和原发肿瘤直径方面相似。
微转移的分子检测是Ⅱ期结直肠癌的一种预后工具。
