常规检查淋巴结阴性No.7组胃癌患者的淋巴结微转移研究

Study on No.7 lymph nodes micrometastasis in patients with node-negative gastric carcinoma by routine examination

目的探讨常规病理检查无淋巴结转移的胃癌淋巴结微转移的特点,并分析微转移与各种临床病理因素的关系。方法应用淋巴结组织连续切片和端粒酶RT-PCRELISA方法检测46例胃癌患者常规病理检查无淋巴结转移的No.7组淋巴结138个,并结合胃癌患者的临床病理资料进行统计学分析。结果本组13例(28.3%)32枚淋巴结(23.2%)经连续切片检出有微转移;而端粒酶阳性表达为20例(43.5%)49枚淋巴结(35.5%)。端粒酶RT-PCRELISA检测敏感性为100%,特异性为84%,阳性预测值为65%,阴性预测值为100%,诊断准确率为88%。淋巴结微转移与患者年龄、性别、原发肿瘤部位、组织学类型和转移淋巴结分型无关(P>0.05),但与原发肿瘤大体类型、大小及是否浸透浆膜有关(P<0.05)。结论对常规病理检查无淋巴结转移的胃癌患者,为客观评价胃癌临床病理分期及其预后,有必要监测其微转移,端粒酶RT-PCRELISA方法可以作为传统组织学检查方法的补充。

Objective To investigate the micrometastatic characteristics in the gastric cancer patients with negative lymph node invasion by routine pathological examination and evaluate the relationship between micrometastasis and clinicopathological features. Methods One hundred and thirty- eight lymph nodes from No. 7 group in 46 patients with node- negative gastric cancer by routine examination were examined by consecutive sections. Telomerase activity was determined by RT- PCR and ELISA. Cliniopathological data were analyzed by statistical method. Results Micrometastasis was found in 32 lymph nodes (23.2% ) from 13 cases (28.3% ) by consecutive sections. Telomerase activity was positive in 49 lymph nodes (35.5% ) from 20 cases (43.5% ). The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of TRAP- ELISA was 100% ,84% ,65% ,100% and 88% respectively. The micrometastasis in lymph node was correlated with age, sex, primary tumor location, histological classification and metastatic lymph node type (P >0.05), but correlated with the gross type of the primary tumor, size and serosa invasion(P< 0.05). Conclusions It is necessary to discern the micrometastasis in gastric cancer with negative lymph node by routine examination in order to objectively evaluate the clinicopathological classification and prognosis. TRAP- ELISA can be a complementary method to traditional histological examination.