Weixler B, et al. - This study incorporated a scrutiny of the association between the occurrence of small nodal tumor infiltrates (SNTI) and bone marrow micrometastases (BMM) as well as their prognostic relevance. No correlation was disclosed between the occurrence of SNTI and BMM in patients with stage I to III colon cancer. Both SNTI and BMM served as independent negative prognostic factors, with regard to the disease-free survival (DFS) and overall survival (OS). Additionally, the occurrence of both was related to prominently worse prognosis compared with either one of them.

Methods

• This research was pursued at 3 university-affiliated institutions in Switzerland between May 2000 and December 2006.
• Statistical analyses were conducted during October 2016.
• The enrollment comprised of 122 patients with stage I to III colon cancer.
• Follow-up time exceeded 6 years, with no patients lost to follow-up.
• As a part of the intervention, bone marrow aspiration from the iliac crests and in vivo sentinel lymph node mapping were carried out during open standard oncological resection.
• Using the pancytokeratin marker A45-B/B3, the bone marrow aspirates were stained.
• All sentinel lymph nodes underwent multilevel sectioning and were stained with hematoxylin-eosin and the pancytokeratin marker AE1/AE3.
• The correlation of SNTI in sentinel lymph nodes and BMM in patients with stage I to III colon cancer and the prognostic effect on disease-free survival (DFS) and overall survival (OS) were encompassed as the primary measure.

Results

• Among the 122 patients, 63 (51.6%) were female, with a mean (SD) age of 71.2 (11.7) years.
• This findings disclosed small nodal tumor infiltrates and BMM in 21 patients (17.2%) and 46 patients (37.7%), respectively.
• No link was noted between the occurrence of BMM with the presence of SNTI by standard correlation (κ, -0.07; 95% CI, -0.29 to 0.14; P=.49) nor by univariate logistic regression analysis (odds ratio, 0.64; 95% CI, 0.22-1.67; P=.37) or multivariate logistic regression analysis (odds ratio, 1.09; 95% CI, 0.34-3.28; P=.88).
• The SNTI presence served as an independent negative prognostic factor for DFS (hazard ratio [HR], 2.93; 95% CI, 1.24-6.93; P=.02) and OS (HR, 4.04; 95% CI, 1.56-10.45; P=.005), along with BMM (HR, 2.07; 95% CI, 1.06-4.06; P=.04; and HR, 2.68; 95% CI, 1.26-5.70; P=.01; respectively).
• The recognition of BMM and SNTI combination, illustrated the poorest DFS (HR, 6.73; 95% CI, 2.29-19.76; P=.006) and OS (HR, 5.96; 95% CI, 1.66-21.49; P=.03).