This study was performed to identify micrometastases in lymph nodes from colorectal cancer considered free of disease by the routine hematoxylin-eosin stain, using immunohistochemistry according to ABC method. All 993 lymph nodes from 56 patients with Dukes'B colorectal cancer were stained retrospectively with antibody against cytokeratin(antikeratin AEl/AE3, Boeringer Mannheim). Single tumor cells and small clusters of tumor cells were detected in nodes of 20 patients(35.7%), mainly in the subcapsular sinuses. Twenty nine of the 36 patients with cytokeratin-negative lymph nodes lived after a mean followup of 55 months. But, 8 of the 20 patients with cytokeratin-positive lymph nodes lived over the same time period. Multivariate analyses were performed with several prognostic factors: age, histologic differentiation, vascular and lymphatic invasion, and presence of micrometastases. The most significant factor for both survival and recurrence was the presence of micrometastases(P= 0.0403 and P=0.0364 respectively). The presence of cytokeratin-positive cells within lymph nodes of Dukes'B colorectal cancer correlated with a poor prognosis.
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