胃黏膜内癌淋巴结微转移的临床意义  

Clinical significance of micrometastasis in lymph nodes of mucosal gastric cancer

作　　者：阎庆辉[1] 刘津[1] 史利克[1] 王凤安[1] 蔡建辉[1] 池口正英[2] 

机构地区：[1]河北医科大学第二医院胃肠外科,河北省石家庄市050000 [2]日本鸟取大学医学部附属病院第一外科

出　　处：《世界华人消化杂志》2006年第20期2026-2029,共4页World Chinese Journal of Digestology

摘　　要：目的：研究胃黏膜内癌淋巴结微转移的发生率、病理学特征及其临床意义.方法：胃黏膜内癌患者84例手术切除淋巴结2526枚进行连续超薄切片,分别进行HE染色及抗Cytokeratin(CK；CAM5.2)免疫组化研究,并与临床病理资料进行对比分析.结果：在84例中16例患者具有淋巴结受累(19%)；2526枚淋巴结中45枚淋巴结受累(1.8%；45/2526),显著高于HE染色的1.2% (1/84；P＜0.05),淋巴结微转移率为18% (15/84).尽管没有显著统计学差异,微转移在大于1.0cm的肿瘤(15/72；21%)较小于或等于1.0cm的肿瘤(1/12；8%)更为多见(P=0.307).大于2.0cm的肿瘤,淋巴结的微转移均为淋巴结内多发散在或聚集状态的肿瘤细胞.结论：胃黏膜内癌具有较高的淋巴结微转移率,内镜下黏膜切除术不宜用于直径大于1.0cm的胃黏膜内癌.AIM： To study the micrometastasis in the lymph nodes of mucosal gastric cancer. METHODS： We examined 2526 lymph nodes from 84 patients with mucosal gastric cancer. Two consecutive sections were prepared, for simultaneous staining with hematoxylin and eosin and immunostaining with CAM 5.2 monoclonal antibody against cytokeratin （CK）, respectively. A clinicopathological comparison was performed between patients with and without lymph node involvement. RESULTS： Lymph node involvement was detected in 45 of 2526 （1.8%） lymph nodes. The incidence of nodal involvement was significantly increased, from 1.2% （1/84 patients） with hematoxylin and eosin staining, to 19% （16/84 patients） with CK immunostaining. Although no significant difference was found, micrometastasis to lymph nodes was more frequently detected in the tumors larger than 1.0 cm （15/72 patients, 21%） than in those less than or equal to 1.0 cm （1/12 patients, 8%, P = 0.307） in diameter. However, discrete CK-positive cancer cells or clusters of CK-positive cancer cells were detected only in the tumors larger than 2.0 cm in diameter. CONCLUSION： Mucosal gastric cancer of more than 1.0 cm in superficial diameter may indicate a risk of micrometastasis to lymph nodes, so endoscopic mucosal resection is not recommended for these patients.

关 键 词：胃黏膜内癌 微转移 CYTOKERATIN 免疫组织化学 

分 类 号：R735.2[医药卫生—肿瘤]