The ‘Sentinel Node’ Concept: More Questions Raised than Answers Provided?

作者：Peter Michael Schlag · 发表于：The Oncologist · 年份：1998 · DOI：10.1634/theoncologist.3-5-0i · 被引用次数：11 · 研究领域：Lung Cancer Diagnosis and Treatment、Cancer Immunotherapy and Biomarkers、Cancer Genomics and Diagnostics

The prognosis of malignant disease is essentially determined by the metastatic potential of the primary tumor. In the past, scientific attention was chiefly directed to systemic metastasis. A multitude of biological and molecular tumor markers and mechanisms has been uncovered enabling a better contemporary understanding of the process of hematogenic metastasis. This is in contrast with our knowledge of the mechanisms and pathways of lymphatic tumor spread, which is rather limited. We do know, however, that adequate surgical clearance of the regional lymphatics improves treatment results of many tumors. How far this lymph node dissection is directly therapeutic is a source of controversy. While in some instances, a stage-adjusted survival benefit was demonstrated, this may very well be attributable at least in part to the phenomenon of stage migration (Will Rodgers phenomenon) through better staging. However, it is uncontested that an established diagnosis of regional lymphatic spread is prognostically significant and should influence the indication for additional therapy and eventually for an intensive follow-up. For many tumors, the indication for adjuvant chemotherapy depends on the nodal status. On the other hand, it is equally well known that aggressive lymphatic dissection increases perioperative morbidity and even mortality. Long-term sequellae from regional lymphatic dissection are common and the effect on the local, maybe even the systemic immunological response to t...