中下段直肠癌预后与淋巴结微转移的关系  

Lymph node micrometastases and its correlation with the prognosis of patients with middle and lower rectal carcinoma

作　　者：吴泽宇[1] 万进[1] 赵刚[1] 杨珏[1] 姚远[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：《中华实验外科杂志》2008年第3期305-306,共2页Chinese Journal of Experimental Surgery

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

摘　　要：目的观察淋巴结微转移对中下段直肠癌预后的影响。方法应用CK-20免疫组织化学技术对56例中下段直肠癌患者共计661枚淋巴结检测微转移。结果20例（35．7％）67枚（10．1％）淋巴结检出微转移。20例检出淋巴结微转移者中10例TNM分期提高：Ⅰ→ⅢA3例，Ⅰ→ⅢC2例，ⅡA→ⅢB3例，ⅢA→ⅢC2例。Kaplan—Meier生存分析显示，淋巴结微转移阳性患者半数生存期为（36．90±3．37）个月（95％置信区间：30．29～43．51个月），明显短于淋巴结微转移阴性者的（48．72±2．25）个月（95％置信区间：44．30～53．14个月），两者差异有统计学意义（P〈0．05）。结论中下段直肠癌淋巴结微转移检测有助于更准确地进行临床病理分期。淋巴结微转移阳性者预后较差。Objective To evaluate the relation of lymph node micrometastasis with prognosis of patients with middle and lower rectal carcinoma. Methods 661 lymph nodes from 56 patients with middle and lower rectal carcinoma who received total mesorectal excision with lymphadenetomy were studied by using immunohistochemistry in addition to histologic examination. Cytokeratin-20 gene marker was used in this assay. Results Micrometastases were identified in 67 （ 10.1% ） lymph nodes from 20 （35.7%） patients. Ten of those 20 patients who were identified with lymph node micrometastases were up-staged （ from Ⅰ stage to ⅢA stage in 3 patients,from Ⅰ stage to ⅢC stage in 2 patients ,from Ⅱ A stage to ⅢB stage in 3 patients, and from Ⅲ A stage to Ⅲ C stage in 2 patients）. Kaplan-Meier survival analysis showed significant improvements in median survival （48.72 ± 2.25 months,95 % CI ： 44.30-53.14 months vs 36.90 ± 3.37 months ,95% CI： 30.29-43.51 months） for patients with negative lymph node micrometastasis over those with positive lymph node micrometastasis （ log-rank,P 〈 0.05 ）. Conclusion Lymph node micrometastases may improve the current staging system of middle and lower rectal carcinoma. Lymph node micrometastases are significant risk factors of prognosis in patients with middle and lower rectal carcinoma.

关 键 词：直肠癌 淋巴结 转移 预后 

分 类 号：R735.2[医药卫生—肿瘤] R735.37[医药卫生—临床医学]