声门上型喉癌颈淋巴结微转移的检测及其预后分析

Study of the lymph node micrometastasis in patients with supraglottic carcinoma

目的：探索检测喉癌颈淋巴结微转移的敏感而可行的方法。方法：对20例声门上型喉癌患者原发部位及其182个颈淋巴结,按颈淋巴结清扫各区分别进行研究。检测手段包括：常规苏木精-伊红染色,角蛋白CK19免疫组化分析。对患者进行3~5年随访,对比其阳性率对患者颈淋巴结转移及预后的相关关系及总体生存率的比较。结果：发现喉鳞状细胞癌原发组织CK19阳性率100%;CK19颈淋巴结阳性率23.6%,常规苏木精-伊红颈淋巴结阳性率16.9%;苏木精-伊红检测在Ⅱ、Ⅲ区分别发现颈淋巴结转移为86.7%,13.3%,CK19在Ⅱ、Ⅲ、Ⅳ区发现颈淋巴结转移为88.4%,9.3%及2.3%。统计学分析,两者阳性率有显著差异,各区颈清扫淋巴结组织阳性率有显著差异,以颈淋巴结清扫Ⅱ区阳性率最高。总体生存时间与2种检测手段分析（LogRank检测）,CK19检测的颈淋巴结转移与生存时间的下降有密切相关性,P〈0.01,而苏木精-伊红检测无相关性。结论：角蛋白CK19免疫组化分析可认为是声门上型喉癌颈淋巴结微转移的有效检测手段,且较高的检出率与患者的生存时间的下降有密切相关性。

Objective：To explore an available and sensitive method to detect cervical lymph node micrometastasis in patients with laryngeal squamous cell carcinoma. Method： The primary tumors and 182 neck lymph nodes from Twenty cases with supraglottic cancer dissection were examined with immunohistochemical （IHC） staining using cytokeratin 19 （CK19）, and haematoxylin and eosin （H＆E） staining. The frequency of lymph node metastasis and the clinical relevance, and the relationship between overall survival time and lymph node metastases by Log Ranktest were analyzed. Result： The expression of CK19 was 23.6% of lymph nodes and all of the primary tumors. In H＆E staining, 16.5% of lymph nodes were positive. There was highly significant difference between them. There were 88.4% lymph nodes, 9.3% lymph nodes and 2.3% lymph node corresponding to the Ⅱ , Ⅲ and Ⅳ levels by IHC. Lymph node metastases were detected on the Ⅱ （86.7%） and Ⅲ levels （13.3%） with H＆E. The highest rate of positive lymph nodes was on the Ⅱ level of the neck. There was highly significant difference between overall survival time and lymph node metastasis in CK19 analysis. Conclusion： The expression of CK19 may be served as an available method to evaluate occult micrometastases in laryngeal squamous cell carci noma. High frequency of CK19 was associated with a decreased probability of survival time.