【作者】 王海磊； 冯美燕； 刘春晓； 王国富； 王宽； 薛英威；

【Author】 Wang Hai-lei;Feng Mei-yan;Liu Chun-xiao;Wang Guo-hu;Wang Kuan;XUE Ying-wei;Deparatment of Gastrointestinal Surgery,the third affiliated hospital,Harbin Medical University;

【机构】 胃肠外科哈尔滨医科大学附属第三医院；

【摘要】 目的:研究淋巴结微转移及临床病理因素对pT1-4aN0M0期胃癌患者术后5年无瘤生存率的影响。方法:纳入我院2008年1月至9月期间pT1-4aN0M0期胃癌患者行根治术者90例1713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,观察其淋巴结发生微转移情况,并分析发生微转移胃癌患者的临床病理特征及微转移的发生对患者5年无瘤生存率的影响。结果:经免疫组化染色,1713枚HE常规染色阴性淋巴结中CK19阳性表达率为8.29%(142/1713);临床病理分期pT1-4aN0M0患者中,CK19表达阳性率高达31.11%(14/45);术后随访时间13月~69月(平均随访时间55.08月),淋巴结中CK19阴性表达、阳性表达患者的5年总生存率分别为84.37%、42.30%;两者无瘤生存率差异有统计学意义(P<0.05)。淋巴结CK19阳性表达与胃癌患者的肿瘤直径(P<0.05)、浸润胃壁深度有关。COX生存回归分析淋巴结微转移为独立预后因素。26名患者被检测出微转移,若以微转移重新分期,发生分期后移的比例为28.89%(26/90)。结论:pT1-4aN0M0期胃癌病人,免疫组化染色能检出常规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。淋巴结微转移与肿瘤的浸润深度、肿瘤直径有关。常规HE染色阴性淋巴结中微转移的存在和对患者预后的影响有待临床重视和深入研究。更多还原

【Abstract】 Objective To investigate the lymph node micrometastasis and its clinicopathologic features on 5-year disease free survival rate for patients with pT1-4aN0M0 gastric cancer.Methods 90 patients with stage pT1-4aN0M0 gastric tumors were enrolled,and 1713 lymph nodes were harvested and examined in all the specimens.There were 10~38 lymph nodes with average 18.87 lymph nodes each patients.All the lymph nodes were negative by HE staining.The CK19 expression of lymph nodes was tested by immunohistochemistry.The relationships between clinicopathologic features or CK positive expression and 5-year disease free survival were analyzed.Results The positive expression rate of CK19 was 8.29%(142/1713) in lymph nodes and 28.89%(26/90) in patients with pT1-4aN0M0 by immunohistochemistry.The average post operative following up was 55.08(range13~69)months.5-year disease free survival rates were 84.37%、42.30%for the lymph node negative group,micrimetastasis positive groups,respectively.5-year DFS(disease free survival rate) in the micrometastasis group was lower than that in negative group(P<0.05).Multivariate analysis identified tumor diameter、 depth of tumor invasion were related with CK19 positive expression.The statistically significant prognostic factor affecting5-year survival rates were depth of tumor invasion.Cox regression survival analysis revealed that the presence of micrometastasis was independent prognostic factors in pT1-4aN0M0 gastric cancer patients.Lymph node micrometastasis of gastric cancer was detected in 26 patients who were recommended restage,the restage rate was 28.89%(26/90).Conclusion Patients with stage pT1-4aN0M0 gastric cancer and lymph node micrometastasis detection in traditional pathologically node-negative gastric cancer is recommended to precisely determine the tumor stage,in order to direct cancer therapy and predict prognosis.Tumor diameter 、 depth of tumor invasion were related with lymph node micrometastasis.The results recommend further investigations on micrometastasis check in HE negative lymph nodes,which may be more important role on patients’ prognosis.更多还原