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. 2017 Aug;24(8):2113-2121.
doi: 10.1245/s10434-017-5818-2. Epub 2017 Mar 3.

Survival Impact of Primary Tumor Lymph Node Status and Circulating Tumor Cells in Patients with Colorectal Liver Metastases

Lars Thomas Seeberg  1   2 , Cathrine Brunborg  3 , Anne Waage  4 , Harald Hugenschmidt  4 , Anne Renolen  5 , Ingunn Stav  5 , Bjørn A Bjørnbeth  4 , Elin Borgen  5 , Bjørn Naume  6   7 , Kristoffer W Brudvik  4 , Gro Wiedswang  4
Affiliations

Survival Impact of Primary Tumor Lymph Node Status and Circulating Tumor Cells in Patients with Colorectal Liver Metastases

Lars Thomas Seeberg et al. Ann Surg Oncol. 2017 Aug.

Abstract

Objective: The aim of this study was to analyse the survival impact of primary tumor nodal status (N0/N+) in patients with resectable colorectal liver metastases (CLM), and to determine the value of circulating and disseminated tumor cells (CTCs/DTCs) in this setting.

Methods: In this prospective study of patients undergoing resection of CLM from 2008 to 2011, peripheral blood was analyzed for CTCs using the CellSearch System®, and bone marrow was sampled for DTC analyses just prior to hepatic resection. The presence of one or more tumor cells was scored as CTC/DTC-positive. Following resection of the primary tumor, the lymph nodes (LNs) were examined by routine histopathological examination.

Results: A total of 140 patients were included in this study; 38 patients (27.1%) were negative at the primary colorectal LN examination (N0). CTCs were detected in 12.1% of all patients; 5.3% of patients in the N0 group and 14.7% of patients in the LN-positive (N+) group (p = 0.156), with the LN-positive group (N+) consisting of both N1 and N2 patients. There was a significant difference in recurrence-free survival (RFS) when analysing the N0 group versus the N+ group (p = 0.007) and CTC-positive versus CTC-negative patients (p = 0.029). In multivariate analysis, CTC positivity was also significantly associated with impaired overall survival (OS) [p = 0.05], whereas DTC positivity was not associated with survival.

Conclusion: In this cohort of resectable CLM patients, 27% had primary N0 colorectal cancer. Assessment of CTC in addition to nodal status may contribute to improved classification of patients into high- and low-risk groups, which has the potential to guide and improve treatment strategies.

Trial registration: ClinicalTrials.gov NCT01919151.

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Figures

Fig. 1
Fig. 1
Study selection process for the cohort of 194 CLM patients, selecting the actual study population of 140 patients with resectable CLM. CLM colorectal liver metastases
Fig. 2
Fig. 2
(a) Recurrence-free survival according to lymph node status (N+/N0) in 140 patients with resectable CLM (p < 0.01). (b) Recurrence-free survival according to CTC status in peripheral blood detected at liver surgery in 140 patients with resectable CLM (p = 0.029). (c) Overall survival analysing lymph node status (N+/N0) in 140 patients with resectable CLM (p = 0.267). (d) Overall survival according to CTC status in the peripheral blood at liver surgery in 140 patients with resectable CLM (p = 0.098). CLM colorectal liver metastases, CTC circulating tumor cells
Fig. 3
Fig. 3
Overall survival analyzing the combination of lymph node status (N+/N0) and CTC status at liver surgery in 140 patients with resectable CLM. CTC circulating tumor cells, CLM colorectal liver metastases
See this image and copyright information in PMC

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