结直肠癌淋巴结微转移的检测及其临床意义

Detection and significance of lymph node micrometastasis in colorectal cancer

目的 探讨结直肠癌淋巴结微转移的发生率 ,研究淋巴结微转移与结直肠癌转移复发的关系。方法 应用免疫组化LSAB法检测结直肠癌肿瘤组织和淋巴结癌胚抗原 (CEA)的表达 ,并采用逆转录聚合酶链反应 (RT -PCR)法检测结直肠癌淋巴结癌胚抗原 (CEA)的表达。结果 免疫组化法示 5 0例Dukes’B期患者 12 8枚淋巴结中发现 10枚淋巴结CEA表达 ,有淋巴结CEA表达的 6例患者全部在术后 5年内出现肿瘤转移或复发 ,而其他 44例患者只有 5例出现肿瘤转移或复发。RT -PCR法示 11例肠癌的 44枚淋巴结中有 12枚淋巴结CEAmRNA表达 ,而病理组织学检查(HE染色 )仅发现 3枚淋巴结存在肿瘤转移 ,免疫组化法发现 4枚淋巴结CEA表达。结论 存在淋巴结微小转移的大肠癌患者预后较差 ,基于RT -PCR的CEA检测可作为早期检测结直肠癌淋巴结微小转移的一种手段 ,为结直肠癌术后辅助化疗提供理论依据。

Objective To investigate lymph node micrometastasis and its relationship with clinicobiological behaviors in colorectal carcinoma. Methods Tumor tissues and lymph nodes from colorectal carcinoma patients were stained against carcinoembryonic antigen (CEA) by labe11ed streptavidin biotin (LSAB) immunohistochemistry method. The mRNA of CEA was detected by reverse transcription polymerase chain reaction (RT-PCR). Results Micrometastasis foci in 10 lymph nodes (6 cases) were found. Patients with micrometastasis lived shorter than those without micrometastasis( P <0.05). Eight lymph nodes exhibited positive expression of CEA mRNA by RT-PCR in 12 HE-stain negative lymph nodes from 3 Dukes'B patients ( P <0.05). Conclusion Colorectal carcinoma patients receiving radical operation have poor prognosis if there is micrometastasis in lymph nodes. The RT-PCR method detecting CEA mRNA can be used for identification of micometastases in early colorectal carcinoma and provides theoretical basis for postoperative adjuvant chemotherapy. [