Sentinel node staging of resectable colon cancer: Results of CALGB 80001

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Abstract
3506 The most important outcome predictor for resectable colon cancer (RCC) is the status of locoregional lymph nodes. This information is critical, as patients with positive nodes may benefit from post-operative adjuvant therapy. A subset of patients with node-negative RCC experiences a poor outcome, suggesting that improved staging would benefit this population by identifying patients who should receive additional treatment. CALGB 80001, a study conducted by 25 surgery-pathology teams at 12 institutions, was designed to determine whether sentinel lymph node sampling (SLNS) could identify a subset of lymph nodes that predict the status of the nodal basin for RCC, and therefore could be extensively evaluated for the presence of metastases. SLNS was performed on 79 of 91 patients enrolled, followed by multilevel sectioning (MLS) of the nodes, and examination by H&E as well as IHC to identify cells positive for cytokeratin (CK) and carcinoembryonic antigen (CEA). Sentinel nodes (SN) were successfully located in 66 of 72 colon cancer cases (92%), with an average of 2.0 sentinel nodes per patient. SNs were negative in 14 of 25 node-positive cases (56%). MLS revealed tumor in a SN in one of these cases, bringing the sensitivity of SN examination by H&E and MLS to 48%. Results of further sentinel node studies are as follows: The addition of IHC for CK and CEA doubled the total number of node positive colon cancer cases from 25 to 50 of 62 (40 to 81%). Conclusion: These results show that SN examined by H&E and MLS failed to predict nodal status in 52% of cases. Analysis of SNs from colon cancer is unlikely to predict the nodal status of the patient, and studies to examine micrometastatic disease should involve all draining nodes removed. No significant financial relationships to disclose.

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