细胞角蛋白20在Ⅰ、Ⅱ期结直肠癌淋巴结微转移患者中的表达及意义

Expression and significance of cytokeratin 20 in lymph node micrometastasis of colorectal cancer in stage and patients in stage Ⅰ and Ⅱ patients

目的通过免疫组化方法检测Ⅰ、Ⅱ期结直肠癌患者细胞角蛋白20(CK20)的表达对淋巴结微转移及预后的影响。方法选择2010年1月至2011年12月中山市人民医院收治的137例Ⅰ、Ⅱ期结直肠癌患者,获取根治性手术切除的淋巴结组织学标本945枚,采用免疫组织化学SP法和单克隆抗体检测淋巴结标本中CK20表达情况,结合临床和随访资料进行生存分析。结果 (1)10例(7.3%)结直肠癌的15枚(1.6%)淋巴结出现微转移,CK20表达阳性。(2)淋巴结CK20的表达情况与Ⅰ、Ⅱ期结直肠癌患者性别、年龄、肿瘤大小、部位、手术方式、原发灶CEA表达情况、组织学类型、有无脉管神经浸润无相关性。(3)5年内复发转移的患者淋巴结CK20的阳性率为16.7%(4/24),远高于未发生复发转移患者的5.3%(6/113),但差异无统计学意义(χ~2=2.282,P=0.131)。生存分析发现,CK20表达阴性组5年生存率高于表达阳性组(84.3%vs 60.0%,P=0.025)。(4)COX回归分析结果显示性别(P=0.359)、年龄(P=0.917)、肿瘤大小(P=0.547)、组织学类型(P=0.106)、原发灶CEA表达情况(P=0.069)、肿瘤位置(P=0.760)、分期(P=0.069)、手术方式(P=0.350)与Ⅰ、Ⅱ期结直肠癌患者预后无明显的相关性;而CK20表达与患者预后密切相关(P=0.033),存在淋巴结微转移的患者死亡的风险是无转移的3.224倍(95%CI=1.100~9.451)。结论 CK20检测结直肠癌淋巴结微转移可以改善结直肠癌患者的临床分期,影响治疗方案,且与患者预后相关。

Objective To assess the impact of cytokeratin 20（CK20） in lymph node micrometastasis on clinical staging and prognosis of colorectal cancer（stage and stage） by immunohistochemistry. MethodsThe original histology of one hundred and thirty-seven patients with stage or stage colorectal cancer who had undergone curative resection from January 2010 to December 2011 in Zhongshan City People＇s Hospital was reviewed. Immunohistochemical staining was performed using CK20 antibodies on all the 945 lymph nodes. The clinical and follow-up data of those patients were used for survival analysis. Results（1） Micrometastases were observed in 15 lymph nodes（1.6%） of 10 patients（7.3%）.（2） The presence of micrometastases was not related to gender, age, tumor size, location, operation methods, CEA expression of the primary lesion, histological type, vascular and nerve invasion.（3） The positive rate of CK20 was 16.7%（4/24） of micrometastasis patients in 5 years, higher than those without recurrence or metastasis 5.3%（6/113, χ~2=2.282, P=0.131）.（4） COX regression analysis showed that gender（P=0.359）, age（P=0.917）, tumor size（P=0.547）, histological type（P=0.106）, CEA expression of the primary lesion（P=0.069）, tumor location（P=0.760）, stage（P=0.069）, and surgeries（P=0.350） were not related to prognosis; but the expression of CK20 was closely related with the prognosis of the patients（P=0.033）, the risk of death in patients with the presenceof lymph node micrometastasis was 3.224 times higher than those without metastasis（95% CI=1.100-9.451）. Conclusion CK20 detection of lymph node micrometastasis in colorectal cancer can improve the clinical stage of colorectal cancer, affect the treatment plan and is related to the prognosis of the patients.