Ⅰ期非小细胞肺癌根治术后区域淋巴结微转移检出率与患者长期生存的关系

Detection of Regional Lymph Node Micrometastasis and Its Impact on Long-term Survival of Non-small Cell Lung Cancer (NSCLC) Patients

背景与目的:非小细胞肺癌(non-small cell lung cancer,NSCLC)根治术后常规病理学诊断无转移的区域淋巴结可通过免疫组织化学等方法检出微转移,其对预后可能产生影响。本研究检测NSCLC根治术后常规病理诊断无转移的区域淋巴结微转移,探讨微转移检出率与生存的关系。方法:收集我院1996年1月至2003年12月经根治术后常规病理证实为pT1～2N0M0的NSCLC78例患者的肺门及纵隔淋巴结存检蜡块684份。选择广谱抗细胞角蛋白(cytokeratin,CK)抗体AE1/AE3,采用EnVision二步法检测CK的表达,结合临床资料分析其与预后的关系。结果:微转移检出率为26.9%(21/78),其中p-ⅠA、p-ⅠB期患者的检出率分别为5.9%(1/17)、32.8%(20/61)。非微转移病例的1、3、5、8年生存率、中位生存期分别为90.80%、69.70%、55.76%、37.17%、87个月,微转移病例分别为60.00%、48.48%、29.09%、0.00%、23个月,差异有统计学意义(P=0.008)。Cox回归分析表明CK、KPS为影响NSCLC患者生存的独立因素(P=0.014,P=0.000)。术后放化疗组对比单纯手术组,放化疗干预有利于延长生存时间,但无统计学意义(P=0.063)。结论:NSCLC淋巴结微转移可能随病情进展检出率增加,淋巴结微转移与患者长期生存相关。

BACKGROUND ＆ OBJECTIVE： Regional lymph node micrometastasis, which can not be found by routine pathologic examination, may be detected by immunohistochemistry after radical operation of tumors, This study was to investigate regional lymph node micrometastasis in non-small cell lung cancer （NSCLC） and its impact on prognosis. METHODS. The expressions of cytokeratin （CK） in 684 specimens from 78 stage pT1-2NOMO NSCLC patients, treated from Jan. 1996 to Dec. 2003, were detected by EnVision method using anti-CK antibody AE1/AE3. The correlation of CK expression to prognosis was analyzed. RESULTS： The overall detection rate of CK was 26.9%; the detection rates were 5.9% in stage p- I A patients and 32.8% in stage p- I B patients. The 1-, 3-, 5-, and 8-year survival rates were significantly higher in non-micrometastasis group than in micrometastasis group （90.80% vs, 60.00%, 69.70% vs. 48.48%, 55.76% vs. 29.09%, and 37.17% vs, 0, P=0.008）; the median survival time were 87 months and 23 months, respectively. CK and KPS score were independent prognostic factors of NSCLC （P=0.014, P〈0.001）. Compared with surgery alone, surgery plus postoperative radiochemotherapy prolonged survival, but the difference was not significant （P=0.063）. CONCLUSIONS： The detection rate of lymph node micrometastases may be increased with the progression of NSCLC, Micrometastasis is an independent prognostic factor of NSCLC.