免疫组织化学和RT-PCR法检测胃癌淋巴结微转移的临床研究

Clinical significance of immunohistochemically and RT-PCR detected micrometastases of the lymph nodes in patients with gastric carcinoma

目的:评价胃癌淋巴结微转移的临床意义。方法:对55例胃癌根治性手术切除的淋巴结转移资料进行回顾性分析,共切取淋巴结1225枚,每例平均切除13-49枚。采用免疫组织化学(IHC)法和逆转录聚合酶链反应(RT-PCR)法同步检测细胞角蛋白20(CK20)和癌胚抗原(CEA)的表达,对比分析胃癌淋巴结微转移与临床病理参数和预后的关系。结果:IHC和RT-PCR法检测淋巴结的转移率从HE染色的74.5%分别上升为83.6%和90.9%;IHC和RT-PCR法检测微转移度分别为7.4%和17.3%;经IHC和RT-PCR法检测重新分期率分别为20.0%和40.0%;淋巴结微转移的发生与肿瘤大小、部位无关,与肿瘤Lauren分型和浸润深度密切相关;肿瘤Lauren分型为独立预后因素。结论:IHC和RT-PCR法是检测胃癌淋巴结微转移的有效手段,能够准确判断临床分期,为制定治疗方案提供依据;微转移与胃癌的预后无明显关系。

Objective： To assesse the clinical significance of micrometastases of lymph nodes in patients with gastric cancer and investigate the correlation between nodal micrometastases and malignancy potentials for determination whether micrometastases of lymph nodes had prognostic significance. Methods： A total of 1 225 lymph nodes taken from 55 patients with average of 22.27 nodes per case had been detected by immunohistochemical techniques and reverse transcriptase-polymerase chain reaction （RT-PCR） assay by using of carcinoemhryonic antigen （CEA） and cytokeratin 20 （CK20） markers. Clinicopathologic parameters and prognosis were compared between patients with and without micrometastases. Results： The incidence of nodal micrometastases increased in 55 patients with gastric cancer from 74.5% by hematoxylin-eosin （H＆E） staining to 83.6% and 90.9% repectively by immunostaining and RT-PCR. The micrometastatic rates of using immunostaining and RT-PCR were 7.4% and 17.3% repectively. The re-stage rates were 20% and 40% repectively by immunostaining and RT-PCR. The presence of micrometastasis was closely correlated with Lauren classification, histological differentiation and tumor depth, but was notcorrelated with tumor site and size. Multivariate analyses showed that the Lauren classification were significant factors for survival time. Conclusions. The current results indicate that the multiple-marker immunohistochemical staining and RT-PCR assay are useful tools for the detection of micrometastases in patients with gastric carcinoma, which may improve the staging system for gastric carcinoma and also assist treatmental programs possibly. Nevertheless, immunohistochemical staining and RT-PCR assay with CEA and CK20 markers seems to be of little prognostic value in patients with gastric carcinoma.