直肠癌系膜内淋巴结微转移及其临床意义分析

Tumor micrometastases in mesorectal lymph nodes in patients with rectal cancer and analysis of the clinical significance.

目的 研究直肠癌系膜内淋巴结 (LN)大小、数目及肿瘤转移和微转移情况 ,探讨直肠系膜LN微转移对预后的影响。方法 收集 2 0 0 1年 10月至 2 0 0 2年 10月行全直肠系膜切除的直肠癌标本 31例 ,检取系膜内LN后以常规病理结合免疫组化染色检测 ,分析直肠癌预后与系膜LN微转移的关系。结果 31例标本共切取LN 5 4 8枚 ,每例 (17 7± 8 2 )枚 ,LN直径 (4 1± 1 8)mm ,转移LN直径 (5 2± 1 7)mm ,微转移LN直径 (3 9± 1 4 )mm。6 6 8%系膜LN、5 2 6 %转移LN及 79 5 %微转移LN直径 <5mm。术后随访 (2 4 6± 4 7)个月 ,5例 (16 7% )病人复发 ,其中 2例死亡 ,3例仍存活。另有 1例死于与肿瘤无关疾病。所有复发病例直肠系膜内均查见 3个以上LN受累。复发组和无复发组平均每例转移LN和微转移LN数目差异均具有显著性。结论 直肠癌系膜内大部分LN、转移LN和微转移LN直径均 <5mm ;直肠癌LN转移和微转移状态 ,以及受累LN数目与病人术后复发有关。

Objective To investigate the number, size, and tumor metastases status in mesorectal lymph nodes and to evaluate the clinical significance of tumor micrometastases in mesorectal lymph nodes in patients with rectal cancer. Methods Thirty-one patients with rectal cancer performed total mesorectal excision from Oct 2001 to Oct 2002 were included. Mesorectal lymph nodes retrieved from the resected specimens were detected with a combination use of haematoxylin and eosin (HE) staining and immunohistochemistry (IHC). The relation between mesorectal lymph nodes tumor micrometastases and the prognosis of patients were analyzed. Results Five hundreds and forty-eight nodes were gotten from 31 specimens, with (17.7±8.2) nodes per case. The mean diameter of all lymph nodes was (4.1±1.8)mm . The mean diameter of metastatic nodes was (5.2±1.7)mm, and that of micrometastatic nodes was (3.9±1.4)mm. Among all the lymph nodes, 66.8% of mesorectal nodes, 52.6% of metastatic nodes and 79.5% of micrometastatic nodes were less than 5mm in diameter. During a median follow-up period of (24.6±4.7)months, 5 patients (16.7%) developed recurrence, with 2 cases dead and 3 cases surviving. Another one case died of causes unrelated to tumor. All 5 recurrent cases had 3 or more nodes involved, with one case developing only lymph nodes micrometastases. The mean number of both metastatic and micrometastatic nodes per case differed significantly between the recurrent and non-recurrent group. Conclusion The majority of lymph nodes, metastatic lymph nodes, and micrometastatic lymph nodes within the mesorectum are less than 5mm in diameter. The metastatic and micrometastatic status as well as the number of involved mesorectal lymph nodes may be relevant to the postoperative recurrence of patients with rectal cancer.