IHC和RT-PCR法对检测胃癌区域淋巴结微转移的价值及其意义

Clinical value and significance of immunohistochemical staining and RT-PCR detected micrometastases of lymph nodes in patients with gastric cancer

目的探讨免疫组织化学方法(IHC)和逆转录聚合酶链反应(RT-PCR)两种方法对检测胃癌区域淋巴结微转移的临床价值及意义。方法对85例胃癌根治性手术切除的淋巴结转移患者的临床资料进行了回顾性分析。共切取淋巴结1835枚,每例平均切除21.7枚。采用IHC和RT-PCR法检测细胞角蛋白20(CK20)的表达,研究淋巴结微转移与临床病理参数和预后的关系。结果患者的淋巴结转移率经IHC法和RT-PCR法检测从HE染色的75.3%分别上升为83.5%和90.6%。经IHC和RT-PCR法检测重新分期率分别为18.8%和37.6%。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。82例完成随访,平均随访时间为21.2个月。微转移与预后无明显关系。结论IHC和RT-PCR法是检测胃癌淋巴结微转移的有效手段,能准确判断临床分期,可为制定治疗方案提供依据。

Objective To investigate the clinical value and significance of immunohistochemical （IHC） techniques and reverse transcriptase-polymerase chain reaction （ RT-PCR ） testing for detecting micrometastases of regional lymph nodes in patients with gastric cancer. Methods A total of 1 835 lymph nodes taken from 85 patients with average of 21. 7 nodes per case were detected by IHC and RT-PCR assay to detect cytokeratin 20 markers. Clinicopathologic parameters and prognosis were compared between patients with and without micrometastases. Results The incidence of nodal micrometastases increased from 75. 3% by hematoxylin-eosin （HE） staining to 83.5 % and 90.6% respectively by immunostaining and RT-PCR in 85 patients with gastric cancer. The presence of micrometastases was closely correlated with Lauren classification and tumor depth, but was not correlated with tumor site and size. The re-stage rate was 18.8% and 37.6% respectively by immunostaining and RT-PCR. Eighty-two patients were followed up at an average time of 21.2 months. Lymph nodal micrometastases seemed to be a little prognostic value in patients with gastric cancer. Conclusions The present results indicate that immunohistochemical staining and RT-PCR assay are useful tools for the detection of micrometastases in the patients with gastric cancer, and may be used to improve the staging system for gastric cancer, and also serve as the basis for decision of therapautic regimen.