临床N0舌鳞癌哨位淋巴结微转移检测及其意义  

Detection of sentinel node micometastases and its clinical significance in tongue cancer with clinically N0 neck

作　　者：彭汉伟[1] 郭朱明[2] 曾宗渊[2] 王顺兰[2] 张诠[2] 

机构地区：[1]汕头大学医学院肿瘤医院头颈外科,广东汕头515031 [2]中山大学肿瘤防治中心头颈外科,广东广州510060

出　　处：《中国口腔颌面外科杂志》2008年第6期410-414,共5页China Journal of Oral and Maxillofacial Surgery

基　　金：广东省医学科研基金(A2002226);广东省科技计划项目(2002-254-3)~~

摘　　要：目的：以CK19mRNA为标志物，采用RT—PCR法检测临床NO舌鳞癌哨位淋巴结（sentinel node。SN）的微转移状况，从基因水平探讨择区颈清扫的必要性。方法：采用1探头示踪法对21例临床NO舌鳞癌患者进行SN示踪，采用RT—PCR法检测CK19基因在SN中的表达，并与颈部慢性炎症淋巴结和舌鳞癌转移淋巴结各10枚的CK19基因表达进行对比。采用SPSS10．0软件包进行X^2检验。结果：21例临床N0舌鳞癌中，20例SN示踪成功，共取得SN53枚，每例1～4枚，平均2．65枚。RT—PCR法检测CK19基因表达诊断颈部淋巴结转移的敏感度为90％，特异度为80％。SN示踪成功的20例中，常规病理检查发现淋巴结转移2例，隐匿性转移率为10％；51枚常规病理阴性的SN中，CK19-mRNA阳性表达11枚（来自7例患者），微转移发生率为21．57％，隐匿性转移率为35％，2种方法评价舌鳞癌隐匿性颈淋巴结转移率有显著性差异，P=0．013。结论：由于微转移的存在，以SN常规病理分析来决定颈清扫术式并不可靠，择区颈清扫仍然是临床NO舌鳞癌颈部治疗的首选方法。PURPOSE： This study was designed to evaluate the feasibility of detecting micrometases of the sentinel nodes （SN） harvested in patients with clinically NO tongue cancer with RT-PCR assay using CK19 mRNA as the marker, as well as to discuss at gene level the necessity of selective neck dissection in tongue cancer with clinically NO neck. METHODS： SNs of 21 cases of tongue cancer with clinically NO neck were detected with handheld γ probe. CK19 gene expression of the harvested SNs was detected with RT-PCR assay. CK19 expression in 10 cervical lymph nodes with chronic inflammation and 10 pathologically proven metastatic lymph nodes were compared with that of the SNs. SPSS10.0 software package was used for Chi-square test. RESULTS： A total of 53 SNs were detected in 20 out of 21 cases of tongue cancer with clinically NO neck. 1-4 SNs were detected in each case, averagely 2.65 SNs per case. The sensitivity and specificity of evaluation of cervical lymph node metastasis by CK19 gene expression with RT-PCR assay were 90% and 80%, respectively. When routine pathologic analysis was used, 2 out of 20 cases whose SNs were detected were found with cervical lymph node metastases, with 10% of occult metastasis. In 51 SNs that were pathologically negative with routine histological examination, 11 SNs from 7 cases were found with expression of CK19-mRNA, with micrometastatic rate of 21.57% and occult metastatic rate of 35%. Occult metastatic rate evaluated by these two methods was significantly different, P=0.013. CONCLUSIONS： Due to mierometastases, it＇s unreliable to select a type of neck dissection according to SN biopsy with routine pathological analysis. Selective neck dissection is still the first choice for neck treatment for clinically NO tongue cancer. Supported by Medical Research Fund of Guangdong Province （Grant No. A2002226） and Scientific and Technological Project of Guangdong Province （Grant No. 2002-254-3）.

关 键 词：舌癌 颈部淋巴结 微转移 

分 类 号：R739.8[医药卫生—肿瘤]