逆转录聚合酶链反应检测结直肠癌淋巴结微转移的临床意义

Clinical Significance of Detecting Lymph Node Micrometastasis of Colorectal Cancer by Reverse Transcriptase-Polymerae Chain Reaction(RT-PCR)

背景与目的:结直肠癌淋巴结微转移灶是否有预测预后价值目前尚有争议,本文对结直肠癌患者淋巴结微转移情况进行逆转录聚合酶链反应(RT-PCR)检测,研究微转移对临床分期和预后的影响。方法:用RT-PCR技术检测56例结直肠癌患者肠旁及系膜淋巴结中细胞角质蛋白CK20mRNA,揭示微转移灶的存在,并与常规病理苏木精伊红(HE)染色和免疫组化染色结果进行比较;分析HE染色和RT-PCR检测结果对判定临床病理分期和统计生存率的影响。结果:共检测432个淋巴结,HE染色、免疫组化染色和RT-PCR法淋巴结转移检出率分别为57.2%、62.3%和73.1%。HE染色和免疫组化的检出率无显著性差异(P>0.05),而HE染色和RT-PCR法检测结果有显著性差异(P<0.05)。56例患者中,按HE染色结果确定的PN0、PN1和PN2期,其5年无复发转移生存率分别为80%、60%和50%;通过RT-PCR技术检测,升级后的PN0、PN1和PN2期5年无复发转移生存率分别为100%、61.9%和55.6%,两种方法分析的结果有显著性差异(P<0.05)。结论:HE染色未确切指出淋巴结微转移癌;RT-PCR法检测CK20mRNA可以推断淋巴结微转移癌的存在,从而有助于确定结直肠癌临床分期和预测预后。

BACKGROUND &OBJECTIVE: It remains controversial whether lymph no de micrometastasis has impact on staging and prognosis of colorectal cancer. This study was to compare the sensitivity of reverse transcriptase-polymerase chain reaction (RT-PCR) in detecting lymph node micrometastasis of colorectal cancer with pathological morphology and immunohistochemistry, and assess the impact of lymph node micrometastasis on clinical staging and prognosis of colorectal cance r. METHODS: Lymph nodes from 56 cases of colorectal cancer radical resection spe cimens were studied by RT-PCR to detect the expression of cytokeratin 20 (CK20) mRNA, and compared with routine pathology detection using hematoxylin and eosin e (HE) staining, and immunohistochemistry using monoclonal antibody specifically against CK20 . The patients had been followed up for 5 years. RESULTS: A total of 432 lymph nodes in 56 patients were analysed by pathological morphology, immu nohistochemistry, and RT-PCR, the detected positive lymph node numbers were 247 (57.2%), 269 (62.3%), and 316 (73.1%), respectively. The difference in metas tatic lymph node numbers was significant between pathological morphology and RT-PCR method (P< 0.05). Five-year disease-free survival rates of PN0,PN1, and PN2 stages detected by RT-PCR method were 100%, 61.9%, and 55.6%, respective ly, significantly higher than those obtained by pathological morphology method, which were 80.0%, 60.0%, and 50.0%, respectively (P< 0.05). CONCLUSIONS: Dete cting lymph node micrometastasis of colorectal cancer with RT-PCR method is mor e sensitive than pathological morphology. RT-PCR method could define the TNM st age and make accurate prognosis for patients with colorectal cancer.