中下段直肠癌淋巴结微转移的临床研究  

Lymph node micrometastases in patients with middle and lower rectal carcinoma

作　　者：万进[1] 吴泽宇[1] 杜嘉林[1] 

机构地区：[1]广东省人民医院普外三区,广州510080

出　　处：《中华普通外科杂志》2007年第1期18-20,共3页Chinese Journal of General Surgery

基　　金：广东省医学科学基金资助项目（WSTJJ2000112736580706003）

摘　　要：目的 探讨淋巴结微转移与中下段直肠癌生物学行为的关系,以及淋巴结微转移对淋巴结分期的影响.方法 应用CK-20免疫组化技术对56例中下段直肠癌共计661枚淋巴结微转移进行检测.结果 20例（36%）67枚（10%）淋巴结检出微转移.肿瘤直径≥5 cm的中下段直肠癌淋巴结微转移检出率为61%（11/18）,而肿瘤直径＜5 cm的淋巴结微转移检出率仅为24%（9/38）（χ^2=7.452,P=0.006）.高分化和中分化直肠癌淋巴结微转移检出率分别为1/5和24%（9/37）,明显低于低分化直肠癌的71%（10/14）（χ^2=10.406,P=0.005）.Ⅰ期、Ⅱ期和Ⅲ期中下段直肠癌淋巴结微转移检出率分别为0、23%（5/22）和52%（15/29）（χ^2=7.361,P=0.022）.中下段直肠癌淋巴结微转移检出率与性别、年龄、肿瘤浸润肠壁周径、Ming分型以及浸润深度无关（χ^2=1.701,P=0.192;χ^2=0.271,P=0.602;χ^2=1.748,P=0.626;χ^2=0.278,P=0.870;χ^2=1.840,P=0.399）.20例检出淋巴结微转移者中10例TNM分期提高：Ⅰ→ⅢA 3例,Ⅰ→ⅢC 2例,ⅡA→ⅢB 3例,ⅢA→ⅢC 2例.结论 CK免疫组化技术可以显著提高中下段直肠癌淋巴结转移的检出率,有助于更准确地进行临床病理分期.淋巴结微转移与肿瘤直径、肿瘤分化程度和分期密切相关.Objective To identify micrometastases in regional lymph nodes in patients with middle and lower rectal carcinoma using immunohistochemistry （IHC） and clarify the relationship between lymph node micrometastases and biological behavior of middle and lower rectal carcinoma. Methods Cytokeratin-20 IHC in addition to hematoxylin and eosin （HE） staining was used to study 661 lymph nodes from 56 patients with middle and lower rectal carcinoma who received total mesorectal excision with lymphadenetomy. Results Lymph node micrometastases were identified in 67 （ 10% ） lymph nodes from 20 （36%） patients. In 18 cancer specimens with tumor diameter≥5 cm lymph node micrometastases were detected in 11 （61%） cases, while in 38 cancer specimens in which tumor diameter was less than 5cm only 9 （24%） were detected with lymph node micrometastases （x^2 = 7.452, P = 0.006）. 71% poorly differentiated cancer specimens were positive with lymph node micrometastases, while it was only 24% and 20% respectively （ x^2 = 10. 406 ,P = 0. 005） in moderate and well-differentiated cancer specimens. Lymph node micrometastases was more frequent in stage m cancer specimens （52%）, compared with stage Ⅱ and Ⅰ cancer specimens （23% and 0% respectively, x^2 =7. 361 ,P =0. 022）. No significant correlations were found between lymph node micrometastases and other variables such as age, gender, Ming classification and depth of tumor invasion （ x^2 = 1. 701, P = 0. 192; x^2 = 0. 271, P = 0. 602; x^2 = 1. 748, P = 0. 626; x^2 = 0. 278,P =0. 870; x^2 = 1. 840,P = 0. 399）. Ten of those twenty patients who were identified with lymph node micrometastases were up-staged （from stage Ⅰ to stageⅢ A in 3 patients, from stage Ⅰ to stage Ⅲ c in 2 patients, from stage Ⅱ A to stage Ⅲ B in 3 patients, from stage Ⅲ A to stage Ⅲc in 2 patients ）. Conclusions The current results indicate that cytokeratin-20 IHC can increase the detection rate of lymph node metastasis and have a significant impact on the sta

关 键 词：直肠肿瘤 肿瘤转移 角蛋白 微转移 

分 类 号：R686[医药卫生—骨科学]