大肠癌前哨淋巴结微转移的检测及其临床意义

Mapping and Detection of Sentinel Lymph Node Micrometastasis in Colorectal Carcinoma and Its Clinical Significance

为探讨大肠癌前哨淋巴结（SLN）微转移（MM）的检测方法及其临床意义，我们对64例行根治性手术的DukesB期大肠癌患者SLN进行定位；应用常规HE染色联合免疫组化SIP法染色，对定位成功的122枚SLN中细胞角蛋白20（CK20）及端粒酶进行检测，并分析其表达与I临床病理因素的相关性。结果显示：（1）SLN定位成功61例（95．3％），共获取SLN122枚。（2）定位成功的61例中，有6例9枚SLN常规HE染色阳性；余55例113枚SLNHE染色阴性，其中免疫组化染色CK20阳性15例（27．3％），端粒酶阳性12例（21．8％），两者联合检测SLNMM阳性21例（38．2％）。（3）DukesB期大肠癌患者SLNMM（＋）组癌的复发转移率明显高于同期SLNMM（-）组（P〈0．05），生存率明显降低（P〈0．05）；而与DukesC期复发转移率及生存率比较，差异无统计学意义（P〉0．05）。（4）SLNMM（-）组患者的复发转移率、生存率与同期DukesC期患者比较，差异有统计学意义（P〈0．05）。（5）DukesB期大肠癌患者SLNMM的发生与患者年龄、性别及肿瘤侵犯肠管周径、生长方式、生长部位均无显著相关，而与肿瘤分化程度及大小、外周血癌胚抗原（CEA）值显著相关。结果表明，应用免疫组化法联合检测CK20和端粒酶，可提高大肠癌SLNMM的检出率；大肠癌SLNMM的检出能精确大肠癌的Dukes分期，有助于指导术后的辅助治疗和预后判断。

In order to investigate the detection method of sentinel lymph node（SLN）micrometastasis （MM） and its clinical significance,authors mapped and detected 122 SLNs successfully in 64 cases,who had Dukes B colorectal carcinoma and received radical procedure, using the routine hematoxylin eosin（HE） and immu- nohistochemical（IHC） staining to detect their cytokeratin 20（CK20） and telomerase in those SLNs,and to analize the correlation between the clinical pathological parameters and SLN MM. Results： （1）The SLNs were identified in 61 of 64 patients（95.3%）,122 SLNs were retrieved; （2）Among the 61 patients,9 SLNs of 6 patients were positive,detected by the conventional HE staining; for the rest 113 SLNs in 55 patients HE stain negative, IHC（immunohistochemistry） was used to detect the micrometastasis. 15 cases（27.3%, 15/55） were CK20 postive in expression,and 12 （21.8%, 12/55） were telomerase positive in expression. Combiniation of the two methods could improve the SLN MM rate as 38.2% （21/55）. （3）The percent of carcinoma recurrence or metastasis of the Dukes B patients with SLN MM （＋） was significantly higher than the patients with SLN MM （-） （ P 〈 0.05）, but the survival rate was significantly lower （ P 〈 0. 05）. However,compared with Dukes C patients, the percents were of no significant difference. （4）The percents of recurrence or metastasis and survival between Dukes C and SLN MM （-） Dukes B patients were significantly different（ P %0.05）. （5） SLN MM of Dukes B eoloreetal carcinoma had no significant correlation with age, gender, intestinal tumor circumference, growth pattern and site of tumor growth, ex- cept for the degree of tumor differentiation,size and peripheral blood carcinoembryonic antigen （CEA） value. The results demonstrate that combiniation of CK20 and telomerase IHC can improve the SLN MM de- tection rate,mapping and detection of SLN MM can accurately confirm the Dukes stage of coloreetal careinoma,thus contributing to the guidance of postoperative adjuvant therapy and prognosis.