淋巴结微转移检测对胃癌病理分期的影响

Value of lymph node micrometastasis detected by RT- PCR assay in determining the stage of gastric carcinoma

目的分析淋巴结微转移对胃癌pN分期的影响。方法采用CK-20mRNA逆转录聚合酶链反应(RT-PCR)技术对2003年12月至2004年4月间行手术切除的30例胃癌患者共计850枚淋巴结扩增检测微转移。结果应用苏木精-伊红染色法淋巴结转移检出率为27.1%(233/850),而RT-PCR法淋巴结转移的检出率则为36.5%(310/850);两种方法比较,P<0.01,差异有统计学意义。77枚淋巴结检出有微转移(12.5%,77/617)。有7例(23.3%)患者的肿瘤TNM分期提高,分别为ⅠB→Ⅱ、ⅠB→ⅢA、Ⅱ→ⅢA、ⅢA→ⅢB、ⅢA→Ⅳ各1例,ⅢB→Ⅳ2例。结论RT-PCR法可以显著提高淋巴结转移的检出率,有助于更准确地进行临床病理分期。

Objective To detect micrometastasis in regional lymph nodes using RT-PCR assay and evaluate the significance of the new assessment of nodal status in determining pN staging in gastric carcinoma. Methods In addition to HE, RT-PCR assay for cytokeratin-20 gene marker was used to detect in 850 lymph nodes from 30 patients with gastric carcinoma who underwent gastrectomy with lymphadenetomy from Dec. 2003 to Apr. 2004. Results The detection rate of HE staining was 27. 1% （233/850）, the detection rate of RT-PCR assay was 36.5% （310/850） （ P 〈 0. 01）. Lymph node micrometastasis was further detected in 77 nodes from 14 patients. The detection rate of RT-PCR assay from the routine negative lymph nodes was 12. 5% （77/617）. Seven of those patients were up-staged （from ⅠB stage to Ⅱ stage, from ⅠB stage to Ⅲ A stage, from Ⅰ stage to ⅢA stage, from Ⅲ A stage to Ⅲ B stage, from ⅢA stage to Ⅳstage in one patient respectively, and from ⅢB stage to Ⅴ stage in 2 patients）. Conclusion RT-PCR assay can increase the detection rate of lymph node metastasis and have a significant impact on the staging system of gastric carcinoma.