CK19在大肠癌淋巴结微转移检测的研究

【作者】 王锡山； 朱景辉； 耿婧姝； 姜世雄； 赵旭海； 王轶慧；

【机构】 哈尔滨医科大学附属肿瘤医院；

【摘要】 目的:研究免疫组化法检测CK19及其在大肠癌淋巴结微转移诊断中的临床病理意义。方法:对64例大肠癌病人339枚癌周淋巴结同时应用HE染色和抗角蛋白19抗体免疫组化法检测淋巴结微转移。对全部病例进行随访。结果: 1、淋巴结HE染色及CK19表达情况339枚淋巴结用HE染色阳性者81枚(23．89％),皆同时表达CK19阳性。另22枚 (6．48％)HE染色阴性的淋巴结CK19表达阳性,19例(19／ 64,29．7％)大肠癌病人检出淋巴结微转移。64例病人中 Dukes B期病人47例,共248枚HE染色阴性淋巴结,CK19 阳性12枚(4．84％,12／248),检出9例病人微转移阳性(9／ 47,19．1％)。2、微转移与临床病理因素的关系微转移的发生与性别(男43例,女21例)、年龄(<60 33例,≥60 31 例)、肿瘤部位(直肠38例,结肠26例)、大体分型(肿块型 24例,溃疡型27例,浸润型13例)无关(P<0．05),与肿瘤的分化程度和Dukes分期有关(P<0．05)。3、微转移与大肠癌预后的关系22例微转移阳性病人,随访5年,由Kaplan- Meier曲线法比较分析微转移阳性组与微转移阴性组生存率存在明显差异(经Log—Rank检验,P<0．05)。CK19阳性组、阴性组复发率分别为68．5％、31．1％,具有显著性差异。结论:免疫组化法是检测大肠癌淋巴结微转移的敏感而便捷的方法,微转移的发生与肿瘤的分化程度和Dukes分期有关, 检测淋巴结微转移有助于判断肿瘤的分期与预后。更多还原

【Abstract】 Objective: To evaluate the relationship between the clinical pathological factors and the micrometastasis of lymph nodes (LN) and the prognosis of patients with colorectal cancer by detecting CK19. Methods: The lymph nodes of 64 patients with colorectal cancer were stained with hematoxylin and eosin (HE) and immunostained with CK19 to detected the micrometastasis of lymph nodes. Results: 1. 23.89% (81/339) of lymph nodes was HE positive and CK19 positive. However, 22 lymph nodes ( 6.48% ) with HE negative was CK19 positive. 29.7% (19/64) of patients were diagnosed as micrometastasis. And 9 patients of Dukes B were diagnosed as micrometastasis. 2. The micrometastasis of lymph node has no correlation with gender, age, position, gross type and the maximal-diameter of the tumor but has correlation with the differentiatrien of the tumor and the Dukes staging. 3. The recurrence rate was 31.1% in the negative group of micrometastasis, 68.5% in the positive group of the micrometastasis, the difference was statistically (P<0.05). Conclusion: Immunohistochemical staining of CK19 is a sensitive and simple method for detecting micrometastasis of lymph nodels and it is valuable to re-estimate the stage of colorectal cancer and predict the prognosis. The tumor with lower differentiatrien get micrometastasis of lymph nodels easily. There was sig- nificant difference between the group of Dukes A,B and Dukes C,D stage for the rate of micrometastasis. The detection of lymph node micrometastasis conduce to Staging and prognosis.更多还原