PN_0胃癌淋巴结微转移的检测及其预后意义

Detection of Micrometastasis in Lymph Nodes and Its Prognostic Significance in Patients with PN_0 Gastric Cancer

目的 评估细胞角蛋白免疫组化染色诊断PN0 胃癌区域淋巴结微转移的临床病理意义。方法 采用免疫组织化学方法 ,用细胞角蛋白 19单抗检测了 3 9例经传统HE染色诊断为无转移 (PN0 )胃癌患者的 3 74个淋巴结。结果 淋巴结微转移率为 3 3 .3 % ( 13 /3 9) ,微转移度为 4.5 % ( 17/3 74) ,微转移与其它临床病理特点无显著相关性 (P >0 .0 5 )。微转移阳性者与阴性者总生存率显著不一致 (P =0 .0 2 73 )。多变量分析表明淋巴结微转移是独立的预后因素。结论 细胞角蛋白 19单抗免疫组化染色方法较常规组织学检查方法敏感性更高 ,提高了淋巴结微转移的检出率和临床分期的准确性。

Objective To evaluate the clinicopathologic significance of the detection of cytokeratin expression with immunohistochemical staining in the diagnosis of micrometastasis in regional lymph nodes in patients with gastric cancer.Methods 374 lymph nodes from 39 gastric cancer patients,diagnosed with no lymph node metastasis with routine hematoxylin and eosin(HE) stains,were examined immunohistochemically for the micrometastases of lymph nodes using anti-cytokeratin 19 monoclonal antibody.Results Lymph node micrometastases were observed in 13 of the 39 patients(33.3%),17(4.5%) of the 374 lymph nodes.No significant correlation was observed between micrometastases and other clinicopathological characteristics(P>0.05).Analysis of overall survival rate showed significant difference between groups with and without micrometastases in lymph nodes(P=0.0273).Multivariate analysis indicated that micrometastases were an independent progrostic factor.Conclusion Immunohistochemical staining using anti-cytokeratin 19 monoclonal antibody is more sensitive than routine histology for detecting micrometastasis in lymph nodes.The clinical stage based on the micrometastasis is more accurate than that based on routine pathology.Lymph node micrometastases play an important role in the prognosis of gastric cancer.