EMA在pT1-3N0胃癌淋巴结微转移检测中的意义

Clinical significance of lymph node micrometastasis of gastric cancer in stage pT1-3N0 detected by EMA immunohistochemistry

目的pT1-3N0期胃癌术后临床病理因素(性别、年龄、肿瘤部位、肿瘤直径、大体分型、浸润胃壁深度、分化程度、血管侵润和淋巴管浸润)和淋巴结微转移对术后5年无瘤生存率的影响。方法纳入研究对象为pT1-3N0期胃癌共有108例,均为胃肠组医师行胃癌根治术。术后平均随访65.12个月(22～120个月),每位患者淋巴结9枚至28枚不等,将所有淋巴结用EMA指标进行免疫组化染色。临床病理因素及微转移对5年无瘤生存率的影响进行统计分析。结果"肿瘤直径"(P=0.033),"浸润胃壁深度"(P=0.024)和"是否有淋巴管浸润"(P=0.005)与淋巴结的上皮膜抗原(EMA)表达有正相关性,而其他临床病理因素与淋巴结EMA表达无明显相关性。临床病理因素对5年无瘤生存率无明显影响。淋巴结EMA表达阴性,孤立肿瘤细胞巢(Isolated Tumor Cells,ITCs)和微转移(Micrometastasis,MCM)的患者,5年无瘤生存率分别为88.50%,75.60%和44.40%。ITCs与EMA(-)的患者5年无瘤生存率无显著差别(P=0.360),而MCM与EMA(-)的患者5年无瘤生存率出现明显差别(P=0.002)。结论对于pT1-3N0期胃癌,若淋巴结中检测出微转移,其预后较差,术后复发率较高,术后应予以积极的辅助治疗。

Objective This study was designed to evaluate the prognostic impact of a wide spectrum of pathologic parameters（gender,age,tumor location,tumor diameter,gross type,depth of invasion,grade of differentiation,vascular invasion and lymphatic invasion） in a consecutive series of homogenously treated and well-characterized patients with stage pT1-3N0 gastric cancer The prognostic value was investigated of lymph node occult disease（micrometastasis） in disease-free survival rate detected by immunohistochemistry with epithelial membrane antigen Methods 108 patients were operated on for stage pT1-3N0 gastric tumors by a single surgeon.The average postoperative follow-up time was 65.12 months（range,22～120 months）.At least 9 more lymph nodes were harvested and examined from tumor specimens.The prognostic value of pathologic parameters,including lymph node occult disease（micrometastasis） detected by immunohistochemistry,was investigated.Results Multivariate analysis identified tumor diameter（P=0.033）,depth of tumor invasion（T1,T2a,T2b or T3;P=0.024） and lymphatic vessel invasion（absent or present;P=0.005） in lymph node shown positive and negative by immunohistochemistry with epithelial membrane antigen.There was no significant difference between the pathologic parameters and the five-year disease-free survival rates.The five-year disease-free survival rates were 88.50%,75.60%and 44.40% for the lymph node negative,isolated tumor cells and micrometastasis groups,respectively.There was significant difference between the lymph node negative and micrometastasis groups（P=0.002）;however,the lymph node negative and isolated tumor cells groups were not significantly diferrent（P=0.360）.Conclusion We propose that in patients with micrometastasis in lymph node with high-risk stage pT1-3N0 gastric cancer,adjuvant therapy may be justified and effective.