非小细胞肺癌淋巴结分子分期的对照研究  

Comparative study on molecular staging of lymph nodes in non-small cell lung cancer patients

作　　者：王云喜[1] 孙玉鹗[1] 李向红[2] 王湛博[2] 童新元[3] 刘元林[4] 

机构地区：[1]中国人民解放军总医院胸外科,北京100853 [2]中国人民解放军总医院病理科,北京100853 [3]中国人民解放军总医院医学统计室,北京100853 [4]军事医学科学院基础医学研究所,北京100850

出　　处：《癌症》2009年第3期318-322,共5页Chinese Journal of Cancer

摘　　要：背景与目的:影响非小细胞肺癌患者术后生存时间的主要因素是其临床病理分期。令人费解的是目前肿瘤复发在Ⅰ期肺癌中并不少见。本研究旨在探讨部分非小细胞肺癌患者常规病理分期是否存在偏低现象。方法:术中采集25例非小细胞肺癌患者淋巴结共195枚,每枚淋巴结平均分成两半。一半淋巴结进行苏木精伊红染色和免疫组织化学染色;另一半淋巴结按区域混合,用于逆转录聚合酶链反应。结果:195枚淋巴结作了苏木精伊红染色病理检查,其中30枚淋巴结发现有显性转移;无一枚淋巴结检出微转移。135枚苏木精伊红染色阴性的淋巴结作了免疫组织化学染色,其中31枚淋巴结中检出微小转移的肿瘤细胞;无一枚淋巴结检出显性转移。39组苏木精伊红染色阴性的区域淋巴结混合组织中,11组逆转录聚合酶链反应呈阳性。免疫组织化学染色和逆转录聚合酶链反应检测肺癌淋巴结微转移的结果存在一致性(U=7.682,P<0.001)。结论:苏木精伊红染色能准确地检测出肺癌患者淋巴结中的显性转移灶,而不易发现隐匿性微转移灶。免疫组织化学染色能够提高肺癌患者淋巴结微转移的检出率。逆转录聚合酶链反应在检测肺癌淋巴结微转移方面,与免疫组织化学染色价值相当。Background and Objective： The postoperative survival of patients with non-small cell lung cancer （NSCLC） is mainly determined by clinical pathologic stage. However, recurrence is not rare in stage Ⅰ NSCLC patients. This study was to explore whether conventional pathologic stages of some NSCLC were underestimated. Methods： A total of 195 lymph nodes were taken from 25 NSCLC patients during operation. Each lymph node was cut into two parts equally, one part was subjected to hematoxylin-eosin （HE） and immunohistochemical （IHC） staining; the other part of the lymph nodes in the same region in a given patient was mixed for reverse transcriptionpolymerase chain reaction （RT-PCR）. Results. With HE staining, 30 of the 195 lymph nodes showed gross nodal metastasis, and none showed micrometastasis. IHC staining was performed on 135 lymph nodes that were identified as free of metastasis by HE staining, 31 showed micrometastasis; none showed gross nodal metastasis. Of 39 groups of mixed regional lymph nodes which were diagnosed to be free of metastasis by HE staining, 11 groups were found to be positive by RT-PCR. There was a correlation between IHC staining and RT-PCR for detection of nodal micrometastasis of NSCLC （U=7.682, P〈0.001）. Conclusions： HE staining can accurately detect gross nodal metastasis in NSCLC patients, but is unfit for detecting nodal micrometastasis, IHC staining can improve the detection rate of occult nodal micrometastasis. RT-PCR has similar value to IHC staining in detecting nodal micrometastasis.

关 键 词：肺肿瘤 淋巴结 分子分期 微转移 免疫组织化学 逆转录聚合酶链反应 诊断 对照研究 

分 类 号：R734.2[医药卫生—肿瘤]