胃癌淋巴结微转移的多种抗体联合检测及其临床价值

Multi-antibody Combined Determination of Lymph Node Micrometastasis in Patients with Gastric Cancer

背景与目的:免疫组化法检测胃癌淋巴结中的微转移灶方法简便,但敏感性差。同时应用多种抗体联合检测淋巴结的微转移情况,是否能提高其敏感性,克服免疫组化法的弱点尚有一些争议。本研究应用细胞角蛋白20(CK20)、上皮膜抗原(EMA)及肿瘤相关糖蛋白72-4(CA72-4)抗体对胃癌阴性淋巴结的微转移情况进行联合检测,旨在评价多种抗体联合检测微转移的应用价值。方法:选取1991年4月至1994年4月行手术切除的未见淋巴结转移的胃癌病例44例,收集其淋巴结蜡块共466个,分别以鼠抗人CK20抗体,鼠抗人EMA单克隆抗体,鼠抗人CA72-4单克隆抗体进行免疫组化染色,显微镜下根据染色结果确定其微转移情况,然后与各病例的临床病理及随访资料进行比较。结果:全组共有18例(40.9%)51个淋巴结(10.9%)发现微转移灶。应用三种抗体免疫组化染色后,检测到的微转移淋巴结数量分别为CK2040个(8.6%),CA72-427个(5.8%),EMA21个(4.5%)。淋巴结微转移与否与患者的性别、年龄、肿瘤部位、组织类型及TNM分期无关(P>0.05)。有微转移的病例5年存活率为(61.11±11.49)%,无微转移的病例为(92.31±5.23)%(P=0.0113);转移淋巴结数≥3个者5年存活率为(44.44±16.56)%,<3个者为(77.78±13.86)%(P=0.0196)。

BACKGROUND &OBJECTIVE: Immunohistochemical staining is a simple method for determination of lymph node micrometastasis in gastric cancer; but the sensitivity is low. Whether this disadvantage can be improved using multi antibody combined determination is still controversial. This study was designed to determine the lymph node micrometastasis in patients with gastric cancer by the antibodies of cytokeratin 20 (CK20), epithelial membrane antigen (EMA), and carcinoembryonic antigen 72 4 (CA72 4)for clarifing the value of multi antibody combined determination of micrometastasis. METHODS: A total of 466 lymph nodes was collected with operation from 44 gastric cancer patients from April 1991 to April 1994. All these lymph nodes showed no lymph node metastasis by routine histological examination. Immunohistochemical staining was performed on all the samples by the mouse antibodies of anti CK 20, mouse anti EMA, and mouse anti CA72 4, respectively. Then, the micrometastases were identified under microscope according to the color of the cells. The results were analyzed according to clinical, pathological, and follow up data. RESULTS: Fifty one (10.9%) lymph nodes of 18 (40.9%) cases showed micrometastasis. The number of micrometastatic lymph nodes were detected by CK20, CA72 4, and EMA was 40 (8.6%), 27 (5.8%), and 21 (4.5%), respectively. There was no significant correlation between the lymph node micrometastasis and clinical data, such as gender, age, tumor site, histological differentiation, and stage (P >0.05). The 5 year survival rate of the patients with lymph node micrometastasis was lower than that of the patients without lymph node micrometastasis(61.11±11.49%vs. 92.31±5.23%, P=0.0113). The 5 year survival rate of the patients with 3 or more positive micrometastatic nodes was lower than that of the patients with less than 3 positive micrometastatic nodes (44.44±16.56%vs. 77.78±13.86%,P=0.0196). CONCLUSION: Immunohistochemical staining marked by different antibodies can be an useful method to seek more micrometastatic lymph nodes in gastric cancer patients.