癌胚抗原在结直肠癌淋巴结微转移检测中的应用

Application of detecting carcinoembryonic antigen in colorectal cancer patients with lymph node micro-metastasis

目的探讨I和Ⅱ期结直肠癌术后病理因素及淋巴结微转移对术后5年无瘤生存率的影响。方法I和Ⅱ期结直肠癌患者共126例，均行结直肠癌根治术。每例结直肠癌患者的淋巴结数平均为16枚（10-28枚），用癌胚抗原（CEA）指标对所有淋巴结进行免疫组化染色。统计分析临床病理因素及微转移对术后5年无瘤生存率的影响。结果术后平均随访64.11（64-106）个月。淋巴管侵犯和肿瘤侵袭深度与淋巴结的CEA表达呈正相关，而其他临床病理因素与淋巴结CEA表达无明显相关性。10项临床病理因素对5年无瘤生存率的影响差异均无统计学意义（P〉0．05）。淋巴结CEA表达阴性、孤立肿瘤细胞巢和微转移患者的5年无瘤生存率分别为75．4％、68．2％和46．2％。孤立肿瘤细胞巢患者与CEA阴性患者5年无瘤生存率比较差异无统计学意义（P=0.245）。微转移患者与CEA阴性患者比较，前者5年无瘤生存率明显较低（P=0.003）。结论对于I和Ⅱ期结直肠癌，若淋巴结中检测到微转移，其预后较差，术后复发率较高，应予以积极的术后辅助化学治疗。

Objective To evaluate the impact of pathologic parameters and lymphatic micrometastasis on 5-year disease-free survival in patients with stages I and Ⅱ colorectal cancer. Methods Surgical operation was performed in 126 patients with stage I and Ⅱ colorectal cancer. Sixteen （range, 10-28） lymph nodes were harvested in each specimen and immunohistochemical staning was performed. The impact of pathologic parameters and lymphatic micrometastases in survival was estimated by Kaplan-Meier. Results The mean follow-up time was 64.11 （range, 64-106） months. Multivariate analysis revealed that lymphatic vessel invasion and depth of tumor invasion were correlated with positive CEA in lymph node, and unrelated with clinical pathologic factors. There was no significant difference between pathologic parameters and five-year disease-free survival rates. The five-year disease-free survival rates was 75.4 percent in CEA negative patients, 68.2 percent in patients with isolated tumor cells, and 46.2 percent in patients positive for micrometastasis. There was no significant difference in 5-year disease-free survival between CEA negative patients and patients with isolated tumor cells （P=0.245）. However, the 5-year disease-free survival was lower in patients positive for micrometastases compared to CEA negative patients （P=0.003）. Conclusions The presence of micrometastases in patients with stages I and Ⅱ colorectal cancer may result in poor prognosis and high recurrence, and adjuvant chemotherapy will be justified and effective.