October 10, 2006 (芝加哥) --“前哨淋巴腺定位(sentinel lymph node mapping)”不常用于大肠直肠癌分期，但根据发表于美国外科医师学会第92届年度
临床研讨会的一篇壁报，此方法应可被运用。
此一多机构临床试验共超过1000位病患，
手术后进行前哨淋巴腺定位的病患的疾病复发率是2.8%，传统手术组病患的疾病复发率是23.5%。
研究指出，传统手术后进行的常规病理检查发现，大肠直肠癌的淋巴结转移高达20%。
此一研究中，研究者选择了1051位可切除的初期大肠直肠癌病患 (平均年纪71岁)，并且将他们发成两组，不过并未提及筛选规范；第一组有582位病患，接受标准前哨淋巴腺定位 (SLNM) 和对前哨淋巴腺额外分期，第二组有469位病患，接受传统手术，共有四位医师在三个机构以相同技术进行SLNM。
该研究之SLNM成功率为98.1%，第一组的582位病患有571进行前哨淋巴腺定位，在这些病患中，49.5%有淋巴结转移，传统手术组则有35.1%(P < .0001)。
据主要作者McLaren Regional医学中心的外科主任Sukamal Saha医师所述，此研究证明了病理学家未曾发现的
癌症病患的淋巴结转移。
Saha医师向Medscape表示，这是此研究的主要原因，帮助病理学家发现已有癌症转移的小淋巴结， 以前无法发现是因为没有人知道要去哪里看。
其他统计中，本研究计算了大肠癌病患至少12个月追踪期后的复发率(平均追踪期 56个月)，此一次组的排除规范，包括诊断时 Tis/To
肿瘤和远端转移疾病，这一次组的病患肿瘤分期为T1到T4，有177位病患是在SLNM组，有149 位病患在传统手术组；另一次组是各个T分期的淋巴结阴性病患，有107位在SLNM组，98位在传统手术组，这些次组中，SLNM组有3件复发(2.8%)，传统手术组有 23件复发(23.5%) 。
Saha医师和同事发现，SLNM对大肠直肠癌病患分期可以比传统手术更具有准确度且有可行性，分期愈高的病患接受更多的化疗，或许可以用来解释何以会复发率降低；此外，某些接受SLNM的病患的肠系膜也被切除，也因而降低了局部且/或区域复发。
加州的一位私人开业医师，Max Savin，在访谈中向Medscape表示，他们的案例不多，但做得非常好，他们让我也想这样做。
当被问到这是否代表在他的临床实务上会有实质改变时，Savin医师表示并不会，是必须做前哨淋巴腺定位，我们这边并不会常规去做，但此方法看起来的确是有用的。
McLaren Regional医学中心的此一研究没有商业赞助。
ACS 92届临床讨论会：壁报SE-161。发表于October 9, 2006。
Sentinel Lymph Node Mapping Significantly Reduces Colorectal Cancer Recurrence
By Richard Hyer
Medscape Medical News
October 10, 2006 (Chicago) — Sentinel lymph node mapping is not commonly used to stage colorectal cancer, but perhaps it should be, according to a poster study presented at the American College of Surgeons 92nd Annual Clinical Congress.
In this multi-institutional clinical trial of more than 1000 patients, disease recurrence was seen in 2.8% of patients whose surgery followed sentinel lymph node mapping compared with 23.5% of patients in the conventional surgery group.
Routine pathological examination following conventional surgery has been found to understage nodal metastases by up to 20% in cases of colorectal cancer, the study noted.
In this study, the researchers selected 1051 patients with resectable primary colorectal cancer (median age, 71 years) and divided them into 2 groups. Selection criteria were not described. One group of 582 patients underwent standardized sentinel lymph node mapping (SLNM) and ultrastaging of the sentinel lymph nodes. A second group of 469 patients underwent conventional surgery. Four surgeons at 3 institutions performed the SLNM using similar techniques.
The SLNM was successful in 98.1% of patients, according to the study, mapping sentinel nodes in 571 of the group's 582 patients. Nodal metastases were found in 49.5% of these patients compared with 35.1% in the conventional surgery group (P < .0001).
According to lead author Sukamal Saha, MD, director of surgery at McLaren Regional Medical Center in Flint, Michigan, the study proves that there are patients with cancer in the lymph node that is not being found by pathologists.
"That is the whole purpose of this study," Dr. Saha told Medscape. "To aid the pathologist to find that small lymph node where cancer has already gone, but they can't find it because nobody knows where to look."
Among other calculations, the study determined recurrence rates for a subset of patients with colon cancer at a minimum follow-up of 12 months (mean follow-up, 56 months). Exclusion criteria for this subset included Tis/To tumors and distant metastatic disease at time of diagnosis. Patients in this subset had tumors staged T1 to T4. There were 177 patients in the SLNM group and 149 patients in the conventional group. A further subset of node-negative patients in all T stages included 107 patients from the SLNM group and 98 patients from the conventional surgery group. Of these subgroups, there were 3 recurrences (2.8%) in the SLNM group vs 23 recurrences (23.5%) in the conventional surgery group.
Dr. Saha and colleagues found SLNM both accurate and feasible for staging colorectal cancer, and they note that it upstaged more patients with colorectal cancer than did conventional surgery. The upstaged patients received more chemotherapy, which in turn explained the decreased recurrence rates. In addition, "extended mesenteric resection in some patients undergoing SLNM may have contributed to decreased local and/or regional recurrences compared to Group B (i.e., conventional surgery) patients," according to the authors.
"Their numbers aren't huge, but they're pretty good," Max Savin, MD, a surgeon in private practice in Escondido, California, told Medscape in an interview for independent comment. "They might make me want to do this."
When asked whether that would represent a substantial change in his clinical practice, Dr. Savin said it would not. "You'd have to do the sentinel node localization," Dr. Savin said. "We're not doing that routinely where I am, but it looks like it might be useful."
The study from McLaren Regional Medical Center had no commercial sponsors.
ACS 92nd Annual Clinical Congress: Poster SE-161. Presented Monday, October 9, 2006.
作者：
Richard Hyer 2007-6-20