Positive lymph nodes do not metastasize

Authors: Jutta Engel Rebecca T Emeny Dieter Hölzel

Publish Date: 2011/12/24

Volume: 31, Issue: 1-2, Pages: 235-246

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Abstract

Our understanding of the role of lymph nodes LN in the metastasization process MET is marginal Positive LNs pLN are the most important prognostic factor and lymph node dissection LND is still standard practice in primary treatment However up to now there is almost no evidence that elective LND has a survival benefit Based on many clinical and experimental findings we propose that tumor foci in regional LN are incapable of metastasization and can therefore not infiltrate further LN and organs Available data demonstrate a very early infiltration of MET capable tumor cells from the primary tumor into regional LN and thereafter an increased probability of subsequent LN infiltrations Disparate growth rates of the first versus subsequent infiltrating tumors as well as the asymptotic growth and prognosis of large tumor foci in LN explain many clinical observations for solid tumors The consequence of the hypothesis “pLN do not metastasize” would impact clinical treatment and research and contribute to understanding the mounting evidence against LND

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