Dukes A、B期大肠癌淋巴结微转移的检测及其对预后的影响

Detection of lymph node micrometastasis in Dukes A and B colorectal cancer patients and its prognostic signifi-cance

目的:探讨Dukes A、B期大肠癌淋巴结微转移的检测和淋巴结微转移对预后的影响。方法:于前瞻性研究31例行根治性手术的Dukes A、B期大肠癌病人,应用逆转录聚合酶链反应(RT-PCR)检测所清除的398枚淋巴结中细胞角蛋白(cytokeratin,CK)20 mRNA的表达以检出微转移;经5年以上的随访,探讨淋巴结微转移对预后的影响和术后复发的可能原因。结果:在31例Dukes A、B期大肠癌病人的398枚淋巴结中,有15例(48.39%)共46枚(11.56%)淋巴结检出微转移。单因素分析提示微转移的淋巴结数量、位置及肿瘤生长方式与术后复发有关;Logistic多元回归模型提示,3枚以上淋巴结发生微转移与复发紧密联系。结论:CK20 RT-PCR是检测Dukes A、B期大肠癌淋巴结微转移灵敏而特异的方法。3枚以上淋巴结发现微转移是预示复发的独立因素。

Objective To study the detection of lymph node mierometastasis in Dukes A and B eolorectal eaneer patients and its prognostic significance in these patients. Methods In a prospective study, 398 lymph nodes obtained from 31 cases of Dukes A and B eolorectal eaneer going curative operation were examined, using reverse transeriptase polymerase chain reaction （RT-PCR） assay to detect cytokeratin 20 （CK20） mRNA expression for identifying mierometastasis. After more than 5 years of follow-up, the prognostic value of lymph nodes mierometastasis and the possible cause of postoperative recurrence were explored. Results Mierometastasis was detected in 46 lymph nodes （11.56%, 46/398） of 15 eases （48.39%, 15/31）. Univariate analysis showed the number and location of the lymph nodes with mierometastasis and the growth pattern of the tumor were closely related with post-operative reeurrence. Logistic regression model indicated that findings of more than 3 lymph nodes with micrometastasis predicted recurrence. Conclusions CK20 RT-PCR assay is a sensitive and specific method to detect lymph nude mierometastasis in the patients with Dukes A and B eulurectal cancer. Findings of more than 3 lymph nodes with micrometastasis is an independent predictor for post-operative recurrence in the patients.