结直肠癌淋巴微转移免疫组化检测及其意义

Clinical significance of lymph node micrometastasis of colorectal cancer detected by immunohistochemistry

目的观察Ⅰ、Ⅱ期结直肠癌术后病理因素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Ⅰ、Ⅱ期结直肠癌患者共126例,均为我院胃肠组行结直肠癌根治术者,术后随访64～106月。平均每例结直肠癌患者检查淋巴结数10枚以上,将所有淋巴结进行免疫组化染色。对10个临床病理因素与免疫组化表达的关系及微转移对5年无瘤生存率的影响进行统计分析。结果多因素分析仅见"淋巴管侵犯"与淋巴结免疫组化表达阳性有正相关,而其他临床病理因素与淋巴结免疫组化表达均无明显相关性。淋巴结免疫组化表达阴性、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78.7%、65.5%和43.8%。ITCs与淋巴结(-)的患者5年无瘤生存率差异无统计学意义(P=0.144),而MCM与淋巴结(-)的患者5年无瘤生存率差异有统计学意义(P=0.005)。结论对于Ⅰ、Ⅱ期结直肠癌患者,若淋巴结中检测出有微转移,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 To evaluate the prognostic impact of a wide spectrum of pathologic parameters in a consecutive series of homogenously treated and well-characterized patients with stage Ⅰ and Ⅱ colorectal cancer,and to investigate the prognostic value of lymph node occult disease（micrometastasis） in disease-free survival rate detected by immunohistochemistry with epithelial membrane antigen and carcinoembryonic antigen. Methods The study included 126 patients operated on by a single surgeon for stage Ⅰ and Ⅱ colorectal tumors.The postoperative follow-up was performed for 64 to 106 months.At least 10 lymph nodes were harvested and examined in all the specimens.The prognostic value of 10 pathologic parameters,including lymph node occult disease（micrometastasis） detected by immunohistochemistry was investigated. Results Multivariate analysis identified lymphatic vessel invasion（absent or present;P=0.009） in lymph node positive and negative by immunohistochemistry.The five-year disease-free survival rates were 78.7%,65.5% and 43.8% 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=0.005）.However,the difference between the lymph node negative and isolated tumor cells groups was not statistically significant（P=0.144）. Conclusions We propose that for patients found micrometastasis in lymph node with high-risk stage Ⅰ and Ⅱ colorectal cancer,adjuvant therapies are justified and effective.