食管癌淋巴结微转移的诊断及预后的前瞻性研究

Lymph node micrometastasis in patients with esophageal cancer: diagnosis and a prospective study of impact on prognosis

目的:探索食管癌淋巴结微转移的基因诊断方法并评价其预后意义. 方法:应用逆转录聚合酶链式反应法(RT-PCR),对63例食管鳞癌患者手术后病理诊断阴性的区域淋巴结(pN0)进行进步研究,检测其Mucin1(myc1)基因mRNA表达,对淋巴结微转移进行基因诊断.对患者随访,应用)X2检验比较患者的生存差别;采用Logistic多因素回归分析,判定独立的预后因素. 结果:淋巴结微转移基因诊断的特异度为100%(30/30);淋巴结微转移基因诊断的灵敏度为90%(27/30).366枚pN0淋巴结中,22例患者(34.9%)的30枚淋巴结(8.2%)检测到myc1基因mRNA的表达,诊断为淋巴结微转移.淋巴结微转移者3a生存率为54.5%(12/22),无转移者3 a生存率为80.5%(33/41),两组相比较差别显著(P<0.01).多因素回归分析结果显示,T3肿瘤(P<0.05,OR=7.17)淋巴结微转移(P<0.05,OR=3.71)是独立的预后因素. 结论:应用RT-PCR法检测食管癌区域淋巴结中myc1基因mRNA的表达,可以诊断淋巴结微转移;淋巴结微转移与pN0患者预后不良有关.

AIM: To investigate genetically diagnostic method of lymph node micrometastasis in patients with esophageal cancer and to evaluate its prognostic significance METHODS: Using assays of reverse transcriptase-poly-merase chain reaction (RT-PCR), three hundred and sixty-six regional lymph nodes obtained from sixty-three patients with squamous cell cancer of the esophagus without invasion confirmed by routine histopathologic analysis (pN0) were studied to further detect mRNA for Mucin1 (myc1) gene and determine micrometastasis. All the patients were followed up. Survival difference was compared by x2test. Logistic regressive analysis was performed to determined independent prognostic factors. RESULTS: Specificity of genetic diagnosis for lymph node micrometastasis was 100% (30/30); Sensitivity of genetic diagnosis for lymph node micrometastasis was 97% (27/30). mycl mRNA was identified in thirty lymph nodes (8.2%) from twenty-two patients (34.9%). Lymph node micrometastasis was diagnosed in these patients. Survival rate at 3-year in patients with nodal micrometastasis (54.5%) was lower than that in patients without nodal micrometastasis (80.5%) (P<0.01). In logistic analysis nodal micrometastasis (P<0.05, OR=3.71) and T3 tumor (P<0.05, OR=7.17) were independent prognostic factors. CONCLUSION: Nodal micrometastasis can be genetically diagnosed by the detection of expression of mycl mRNA in lymph node of patients with pN0 esophageal carcinoma; Poorer prognosis after radical surgery in the patients may be correlated with nodal micrometastasis.