检测pT_(1-4a)N_(1-3)M_0期胃癌淋巴结微转移检测的临床意义

Clinical Significance of Lymph Node Micrometastasis on Patients with pT_(1-4a)N_(1-3)M_0 in Gastric Cancer

目的：探讨胃癌淋巴结微转移及临床病理因素对p T1-4aN1-3M0期胃癌患者术后5年无瘤生存率的影响。方法：选取我院2009年1月至12月期间胃肠外科单一手术组行D2胃癌根治术p T1-4aN1-3M0期患者63例1427枚HE染色阴性淋巴结,应用免疫组化法检测这些淋巴结中CK19表达,观察微转移的情况并分析发生微转移的胃癌患者临床病理特征及对患者5年无瘤生存率的影响。结果：临床病理分期p T1-4aN1-3M0胃癌患者中,经免疫组化染色,1427枚HE常规染色阴性淋巴结中CK19阳性表达率为15.49%（221/1427）;63例胃癌患者中CK19表达阳性率39.68%（25/63）;术后随访时间5.6-68.5月（平均时间43.88月）,淋巴结中CK19阴性表达、阳性表达患者的总5年生存率分别为52.63%、28.00%;两者无瘤生存率差异有统计学意义（Х^2=8.677,P=0.003）。淋巴结CK19阳性表达与胃癌患者的肿瘤直径（P〈0.05）、浸润胃壁深度（P〈0.05）有关。COX生存回归分析显示淋巴结微转移为独立预后因素。25例患者发现淋巴结微转移并推荐再分期,再分期率39.68%（25/63）。结论：p T1-4aN1-3M0期胃癌病人,CK-19免疫组化法染色能检出常规HE染色阴性淋巴结中的微转移,有助于细化分期、判断预后及指导治疗。

Objective： To detect the effects of lymph node micrometastasis and clinicopathologic characteristics on 5-years of disease free survival rate of patients with p T1-4aN1-3M0 in gastric cancer. Methods： Sixty-three patients of gastric carcinoma with p T1-4aN1-3M0 stage who underwent gastrectomy with lymphhadenetomy from January 2009 to December 2009 were enrolled, and 1427 lymph nodes were harvested in all specimens. All the lymph nodes were negative by HE staining, and were tested by immunohistochemistry again for CK19 expression. The lymph node micrometastasis or not was observed, and the relationships between CK19 positive and clinicopathologic characteristics on 5-years of disease free survival rate of patients with p T1-4aN1-3M0 in gastric cancer was analyzed. Results： The positive expression rate of CK19 was 15.49 % in these negative lymph nodes（221/1427） and 39.68 % in the 63 cases of patients by immunohistochemistry. The detection of 5-years of disease free survival were 52.63 % and 28.00 % in negative and positive CK19 expression in follow up of 5.6-68.5（average：43.88） months, and the difference had statistical significance（Х^2=8.677, P=0.003）. Multivariate analysis identified tumor diameter and depth of tumor invasion were related with CK-19 positive expression. Cox survival regression analysis indicated that lymph node micrometastasis was independent clinicopathologic characteristics in patients with p Tx N1-3M0 of gastric cancer. Twenty-five patients were detected lymph node micrometastasis and recommend restage, the rate of restage was 39.68 %（25/63）. Conclusions： Immunohistochemistry can detect lymph node micrometastasis who express negative by Hematoxylin-eosin staining in stage p T1-4aN1-3M0 gastric cancer, which will contribute to correct staging and judge prognosis of this disease.