48 - Preissitzung
Felix Largiadèr Preissitzung
16. Mai 2019, 10:15 - 11:45, Bellavista 3+4, 6. OG
Sentinel lymph node mapping significantly improves the staging of patients with node negative colon cancer
B. Weixler1, 2, R. Warschkow3, 4, U. Güller3, A. Zettl5, M. Ramser5, S. Texeira da Cunha2, J. Rueff2, C. Kettelhack5, M. Zuber2, Presenter: B. Weixler1 (1Berlin/DE, 2Olten, 3St. Gallen, 4Heidelberg/DE, 5Basel)
Lymph node (LN) involvement is the key deciding factor for administration of adjuvant chemotherapy, generally reserved for patients with node positive colon cancer. Up to 20% of stage I & II patients develop recurrence. Conventional histopathological LN examination may be limited in describing the real metastatic burden of LN. Sentinel lymph node (SLN) mapping could more precisely evaluate the LN status.
Of 312 patients with stage I & II colon cancer operated at two Swiss academic centers between 2000 and 2014 data were collected prospectively. SLN mapping was initially performed as part of a previously published study and was thereafter continued as a standard procedure in one of the two centers. All SLN underwent multilevel sectioning and staining with AE1/AE3 or CK19. The value of the SLN mapping compared to conventional staining for the detection of tumor-free patients was assessed using Cox regression analyses.
SLN mapping was performed in 143 patients. Disease recurrence was observed in 13 (9.1%) patients staged with SLN mapping and in 27 (16%) staged conventionally. Five-year overall survival (OS) and cancer specific survival (CS) rates were 82.7% (95% confidence interval [CI]: 76.5-89.4) and 95.1% (95%CI: 91.3-99.0) with SLN mapping and 65.8% (95%CI: 58.8-73.7) and 92.5% (95%CI: 88.0-97.2) with conventional staging. In univariate and multivariate analysis node negative staging with SLN mapping was associated with significantly better OS (hazard ratio[HR] = 0.59 (0.44-0.80), p < 0.001; HR = 0.64 (0.56-0.72), p < 0.001) and CS (HR = 0.72 (0.58-0.88), p = 0.002; HR = 0.49 (0.39-0.61), p < 0.001), respectively
SLN mapping with multilevel sectioning provides a more precise staging. It more accurately identifies patients that are “real” LN negative, leading to a significantly better OS and CS compared with conventional staging.