【作者】 于跃明； 王贵英； 马志强； 何景利； 于滨； 张振亚； 安广权；

【Author】 Yu Yue-Ming Wang Gui-Ying Ma Zhi-Qiang et al. The Second Department of Surgery, The Fourth Hospital of Hebei medical university & Hebei provincial tumor hospital, Shijiazhuang, 050011, China

【机构】 河北医科大学第四医院暨河北省肿瘤医院外科；

【摘要】 目的:评价腹膜返折以下直肠癌微转移中CK20的检测对病理分期的意义。方法:采用RT-PER方法,对35 例低位直肠癌患者腹腔灌洗液及区域淋巴结进行CK20 mRNA的检测,准确判断低位直肠癌患者腹腔灌洗液以及淋巴结中是否存在低位直肠癌微转移,对比常规病理检测,力图探讨对肿瘤分期,规范治疗以及预后的影响。结果:随着 Dukes分期的进展,用常规病理和RT-PCR方法检测腹腔灌洗液中癌细胞检出率均逐渐增加;RT-PCR检测腹腔灌洗液中癌细胞其检出率明显优于细胞学检测;在肿瘤不同的浸润深度下,腹腔灌洗液中CK20 mRNA的表达差异显著;应用 RT—PCR方法检测各站区域淋巴结是否存在转移灶,其灵敏度均明显高于常规病理方法;35例低位直肠癌患者中,经常规病理检测,DukesA,B期有9例,DukesC期有21例,而经RT-PCR检测后,9例DukesA、B期患者中有7例患者转为DukesC、D期,经统计学分析,表明RT-PCR检测有助于更准确的进行临床分期;病理诊断淋巴结阳性的患者中,腹腔灌洗液CK20阳性检出率高;我们随访了术后3年的患者, 根据RT-PCR方法划分病理分期的病人,复发转移多集中于 DukesC、D期,与常规病理分期相比,根据RT-PCR划分病理分期,更符合大肠癌的病程发展规律。结论:RT—PCR 方法检测有助于发现是否存在腹膜返折下直肠癌微转移,可更准确的指导病理分期及治疗,同时提示加强对直肠癌微转移的相应治疗和改善患者术后生存质量,降低复发与转移,对临床有较高的应用价值。更多还原

【Abstract】 Objective: To evaluate the significance of CK20 detection to clinical stage in the peritoneal washes and lymph nodes of rectal cancer located below the peri- toneal reflection. Methods: CK20 mRNA was detected by RT-PCR in the peritoneal washes and local lymph nodes of 35 patients with lower rectal cancer. Then, the status of micrometastasis in those tissues was defined, and compared with the routine pathological results, with the aim to investigate the effects of CK20 detection to the stage, treatment, and prognosis of rectal cancer. Results: The detection rates of cancer cells in the peritoneal washes by both cytology examination and RT-PCR were increased with the development of Dukes stage. The detection rates of cancer cells by RT-PCR were higher obviously than that by cytology examination. The expression of CK20 mRNA in the peritoneal washes varied with the invasion depth of tumors. The sensitivity of metastasis detection in lymph nodes by RT-PCR was higher than that by cytology examination. According to the RT-PCR results, 7 in 9 cases of patients with Dukes A, and B were changed to Dukes C, and D. The statistics data suggested RT-PCR detection was of help to more accurate clinical stage. The detection rates of cancer cells in the peritoneal washes were higher in patients with lymph node metastasis. We also collected the follow-up data for 3 years. The recurrences were more likely to concentrate in Dukes C and D according to the RT-PCR results. It suggested that the Dukes stage of rectal cancer by RT-PCR were more consistent with the develop rule of rectal cancer. Conclusion: RT-PCR detection is helpful to find the micrometastasis in the rectal cancer located below the peritoneal reflection, which can guide the clinical stage and treatment accurately. We also suggest that combined treatment should be strengthened to patients with micrometastasis, to decrease the recurrence and metastasis, and to improve the patients’ survival qualities.更多还原