Prognostic value of whole lymph node molecular analysis in colorectal cancer: a prospective multicenter study

Lymph node (LN)-negative colorectal cancer (CRC) patients may be understaged by conventional hematoxylin and eosin for its low sensitivity for detecting LN micrometastasis (LNM). The one-step nucleic acid amplification assay (OSNA) has shown superior performance in detecting LNM. To date, OSNA studies in CRC have analyzed part of the LN tissue with OSNA and part with H&E, introducing a tissue allocation bias for LNM detection. We aimed to evaluate the prognostic significance of the whole LN molecular analysis using OSNA in CRC patients. This prospective multicenter study analyzed LNs from stage I-III CRC by both cytology smears (CS) and OSNA, the latter analyzing the whole LN tissue and reported as the Total Tumor Load (TTL). X-tile software was used to determine the optimal TTL threshold. Cox proportional hazard and Kaplan-Meier estimation were used to assess the prognostic significance of TTL for both cancer-specific survival (CSS) and recurrence-free survival (RFS). 158 CRC patients were included, with 156 eligible for survival analysis. A TTL of 15,000 copies/µL was identified as the optimal cut-off, stratifying CRC patients into low and high risk for both CSS and RFS (P < 0.05). Conversely, CS pN-positive patients with TTL ≤ 15,000 copies/μL had comparable long-term outcomes to CS pN-negative patients (P > 0.05). A TTL threshold of > 15,000 copies/μL has prognostic value as it identifies CRC patients with significantly reduced CSS and RFS. The clinical implementation of the whole LN analysis by OSNA allows accurate patient risk stratification and optimizes postsurgical management.

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Publication Details

Journal
Clinical and Experimental Medicine
Published
2025-11-25
DOI
https://doi.org/10.1007/s10238-025-01936-0
Primary Topic
Colorectal Cancer Surgical Treatments
Type
article
Field-Weighted Citation Impact
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article

Prognostic value of whole lymph node molecular analysis in colorectal cancer: a prospective multicenter study

Míriam Cuatrecasas, Isidro Machado, Raquel Gómez Bravo, Ignacio Pinilla-Pagnon et al.
Clinical and Experimental Medicine
Colorectal Cancer Surgical Treatments
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Prognostic value of whole lymph node molecular analysis in colorectal cancer: a prospective multicenter study

Míriam Cuatrecasas, Isidro Machado, Raquel Gómez Bravo, Ignacio Pinilla-Pagnon, Sandra López‐Prades, Joan Maurel, Qing Liu, Ángel Romo Navarro, Jordi Camps, Jordi Tarragona, Manuel Berenguel, Iván Archilla, Juan Ruiz Martín, Maria Teresa Rodrigo‐Calvo, Karmele Sáez de Gordoa
article en

Abstract

Lymph node (LN)-negative colorectal cancer (CRC) patients may be understaged by conventional hematoxylin and eosin for its low sensitivity for detecting LN micrometastasis (LNM). The one-step nucleic acid amplification assay (OSNA) has shown superior performance in detecting LNM. To date, OSNA studies in CRC have analyzed part of the LN tissue with OSNA and part with H&E, introducing a tissue allocation bias for LNM detection. We aimed to evaluate the prognostic significance of the whole LN molecular analysis using OSNA in CRC patients. This prospective multicenter study analyzed LNs from stage I-III CRC by both cytology smears (CS) and OSNA, the latter analyzing the whole LN tissue and reported as the Total Tumor Load (TTL). X-tile software was used to determine the optimal TTL threshold. Cox proportional hazard and Kaplan-Meier estimation were used to assess the prognostic significance of TTL for both cancer-specific survival (CSS) and recurrence-free survival (RFS). 158 CRC patients were included, with 156 eligible for survival analysis. A TTL of 15,000 copies/µL was identified as the optimal cut-off, stratifying CRC patients into low and high risk for both CSS and RFS (P < 0.05). Conversely, CS pN-positive patients with TTL ≤ 15,000 copies/μL had comparable long-term outcomes to CS pN-negative patients (P > 0.05). A TTL threshold of > 15,000 copies/μL has prognostic value as it identifies CRC patients with significantly reduced CSS and RFS. The clinical implementation of the whole LN analysis by OSNA allows accurate patient risk stratification and optimizes postsurgical management.

Clinical and Experimental MedicineVol. 26(1)
Universitat Autònoma de Barcelona (ES), Hospital Universitari Arnau de Vilanova (ES), ProMedica Toledo Hospital (US), Valencian Infertility Institute (ES), Fundación Instituto Valenciano de Oncología (ES), Hospital Clínic de Barcelona (ES), Instituto Valenciano de la Edificación (ES), Complejo Hospitalario Torrecárdenas (ES), Hospital Universitario Severo Ochoa (ES), Consorci Institut D'Investigacions Biomediques August Pi I Sunyer (ES), Complejo Hospitalario Universitario de Toledo (ES), Universitat de Barcelona (ES)
Centres de Recerca de Catalunya, Generalitat de Catalunya, China Scholarship Council, Universitat de Barcelona, Universitat Autònoma de Barcelona, Xarxa de Bancs de Tumors de Catalunya, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Agència de Gestió d'Ajuts Universitaris i de Recerca, Instituto de Salud Carlos III, European Regional Development Fund
Openalex Percentile: Top 50%
Colorectal Cancer Surgical Treatments
DOIOpen Access PDFOpenAlex
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