Occult Tumor Cells in Lymph Nodes As a Predictor for Tumor Relapse in Pancreatic Adenocarcinoma

Overview

Journal Langenbecks Arch Surg

Specialty General Surgery

Date 2007 Aug 21

PMID 17704938

Citations 6

Authors

Peter Scheunemann

Nikolas H Stoecklein

Alexander Rehders

Minu Bidde

Sylvia Metz

Matthias Peiper

Claus F Eisenberger

Jan Schulte Am Esch

Wolfram T Knoefel

Stefan B Hosch

Affiliations

Soon will be listed here.

Abstract

Background And Aims: Occurrence of tumor relapse is frequent in patients with pancreatic cancer despite the absence of residual tumor detectable at primary surgery and in histopathological examination. Therefore, it has to be assumed that current tumor staging procedures fail to identify minimal amounts of disseminated tumor cells, which might be precursors of subsequent metastatic relapse. The aim of this study was to assess the prognostic impact of minimal tumor cell spread detected in lymph nodes classified as "tumor-free" in routine histopathologic evaluation.

Materials And Methods: A total of 154 "tumor-free" lymph nodes from 59 patients with pancreatic cancer who underwent intentionally curative tumor resection were examined by immunohistochemistry for disseminated tumor cells.

Results: Fifty (32.5%) of the "tumor-free" lymph nodes obtained from 36 (61%) patients displayed disseminated tumor cells. Multivariate survival analysis revealed that the presence of disseminated tumor cells in "tumor-free" lymph nodes is an independent prognostic factor for both a significantly reduced relapse-free survival (p = 0.03) and overall survival (p = 0.02).

Conclusions: The frequent occurrence and prognostic impact of immunohistochemically identifiable disseminated tumor cells in lymph nodes of patients with operable pancreatic cancer supports the need for a refined staging system of excised lymph nodes, which should include immunohistochemical examination.

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