新辅助化疗对Ⅲ期胃癌的疗效及对树突状细胞免疫功能的影响

The impact of neoadjuvant chemotherapy on lymph node micrometastasis and dendritic cells in patients with stage Ⅲ gastric carcinoma

目的 评价新辅助化疗治疗Ⅲ期胃癌淋巴结微转移疗效及树突状细胞（dendritic cells,DC）相关免疫学改变.方法 新辅助化疗56例和未行新辅助化疗20例共76例Ⅲ期胃癌患者术后常规病理检测阴性淋巴结,采用免疫组化方法检测CK-20的表达.对76例Ⅲ期胃癌患者的HE（＋）淋巴结、HE（-）的近癌灶淋巴结、HE（-）的远癌灶淋巴结标本采用免疫组化方法检测DC的数量.结果 在新辅助化疗组2例患者存在微转移（2/56）,未新辅助化疗组均检测出微转移（20/20）,差异有统计学意义（x2=66.623,P=0.000）.HE阳性淋巴结群：2次化疗组、3次化疗组、4次化疗组CD83阳性DC数量较未化疗组均有显著增多（P20 =0.001、P30=0.000、P40 =0.000）；HE阴性的近癌灶淋巴结群：3次化疗组、4次化疗组CD83阳性DC的数量较未化疗组显著增多（P30=0.001、P40=0.001）；HE阴性的远癌灶淋巴结群：4次化疗组CD83阳性DC的数量明显高于未化疗组、2次化疗组和3次化疗组,差异均有统计学意义（P40 =0.000、P42=0.000、P43=0.001）.结论 新辅助化疗能有效控制Ⅲ期胃癌淋巴结微转移,并上调淋巴结中成熟DC的数量.

Objective To evaluate the effect of neoadjuvant chemotherapy on lymph node micrometastasis and DC cell number in stage Ⅲ gastric cancer patients.Methods Lymph node micrometastases in pathologically negative lymph nodes from 76 stage Ⅲ gastric cancer patients [56 cases with neoadjavant chemotherapy （NCT） and 20 cases without],were assessed by cytokeratin-20 antibody.Dendritic cells （DC） in HE positive lymph nodes,HE negatives near tumor foci and HE negatives far foci were assessed by CD83 antibody respectively.Patients were divided into four groups：group 0 （20 cases without NCT）,group 2 （two courses of NCT in 29 patients）,group 3 （three courses of NCT in 16 patients）,group 4 （four courses of NCT in 11 patients）.Results In NCT group there were two patients with micrometastases （2/56）.All the patients were with micrometastases in control group （20/20）.Difference was statistically significant （P =0.000）.In HE-positive lymph node group：the number of CD83-positive DC in 2 times group,3 times group,and 4 times group when compared with no chemotherapy group were statistically significant （P20 =0.001,P30 =0.000,P40 =0.000）.In HE-negative lymph node near foci group：the number of CD83-positive DC in 3 times group,and 4 times group compared with 0 group were statistically significant increased （P30 =0.001,P40 =0.001）.In HE-negative lymph node far foci group：the number of 4 times group was significantly higher than 0,2 and 3 group （P40 =0.000,P42 =0.000,P43 =0.001）.Conclusions Neoadjuvant chemotherapy is effective in the prevention of lymph node micrometastases in stage Ⅲ gastric carcinoma and it increases the number of mature dendritic cells in lymph nodes.