Ⅰ期非小细胞肺癌淋巴结微转移规律的研究  

The study on the rule of nodal occult micrometastasis in stage Ⅰ non - small - cell lung cancer

作　　者：闫作义[1] 康洁[1] 李栋[1] 衣翠红[1] 张磊[1] 

机构地区：[1]威海市文登中心医院胸外科,山东文登264400

出　　处：《现代保健（医学创新研究）》2007年第11Z期1-3,共3页

摘　　要：目的探讨几个问题：（1）Ⅰ期非小细胞肺癌淋巴结微转移比率；（2）淋巴结微转移与肿瘤大小、病理类型、细胞分化程度、部位、分型、分期进行Logstic回归分析，确定影响微转移的主要因素；（3）探讨微转移的方式、顺序。方法对91例非小细胞肺癌清扫的肺门和隆突下淋巴结进行MCK（AEI／AE3）免疫组化标志检测微转移的存在。另外收集45例肺部良性病变手术时切除的肺门淋巴结45枚和Ⅱ期、Ⅲ期肺癌常规病理检查阳性的肺门淋巴结45枚进行MCK（AEI／AE3）免疫组化（SP法）标志，分别作为阴性和阳性对照。结果45例肺部良性病变手术时切除的肺门淋巴结45枚进行MCK（AEI／AE3）免疫组化标志均为阴性；Ⅱ期和Ⅲ期常规病理检查阳性的肺门淋巴结45枚进行MCK（AEI／AE3）免疫组化标志均为阳性。91例Ⅰ期非小细胞肺癌总的微转移率为49％（45／91）。结论Ⅰ期非小细胞肺癌淋巴结中存在微转移；Ⅰb期非小细胞肺癌微转移率明显高于Ⅰa期；有必要对Ⅰb期非小细胞肺癌进行术后化疗；肿瘤分期和分化程度是影响淋巴结微转移的主要因素；淋巴结微转移遵循肺门到纵隔的途径；腺癌存在跳跃式微转移。Objective The following questions were discussed in order to guide clinical therapy. （ 1 ） The rate of nodal micrometastasis. （2） By Logistic regression analysis, to deduce the main factor that affected micrometastasis from following aspects ： age, gender, tumor size, histological types, location, cells differentiation and pathologic T - stage. （3） The method and order of micrometastasis. Methods A total of 91 hilar and 91 subcarinal LNs removed during surgery from 91 patients with completely resected stage Ⅰ NSCLC. With another 45 hilar LNs were removed from benign pulmonary lesion patients and 45 hilar LNs which were negative by conventional histopathologic examination and removed from Ⅱ and Ⅲ stage lung cancer patient as control. The LNs were analyzed for micrometastasis using immunohistochemistry（ SP method） with the monoclonal anti- CK antibody AE1/AE3. Results Micrometastasis was detected in all lymph nodes that were removed from Ⅱ and Ⅲ stage lung cancer patient, but no one in lymph nodes that were removed from benign pulmonary lesion patients. The rate of micrometastasis in Ⅰ stage NSCLC was 49% （45/91）. Conclusion There were nodal micrometastasis in completely resected stage Ⅰ NSCLC patients. The micrometastasis frequency of Ⅰb stage was significantly higher than Ⅰa stage; It was necessary for Ⅰb stage NSCLC to be given chemotherapy after operation; Cell differentiation and T stage may be the adverse factors for nodal micrometastasis. The method of lymphnode micrometastasis was from hilum to mediastinum. The skip micrometastasis may be taken place in adenocarcinoma.

关 键 词：非小细胞肺癌(NSCLC) 微转移 混合性细胞角蛋白(MCK) 

分 类 号：R734.2[医药卫生—肿瘤]