pT_(1～3)N_0期胃癌淋巴结微转移检测的临床意义  

Clinical Significance of Lymph Node Micrometastasis on Patients with pT_(1-3)N_0 Gastric Cancer

作　　者：陶国强[1] 严轶群[1] 王兴祥[1] 王嘉民[1] 王校红[1] 

机构地区：[1]上海市浦南医院普外科,上海200125

出　　处：《中国普外基础与临床杂志》2010年第6期596-600,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的研究淋巴结微转移及临床病理因素对pT1～3N0期胃癌患者术后5年无瘤生存率的影响。方法纳入我院2000年1月至2004年12月期间pT1～3N0期胃癌患者行根治术者120例2106枚淋巴结,每例患者淋巴结9～28枚,平均18枚,所有淋巴结经HE染色均为阴性。应用免疫组化染色法检测淋巴结中CK20表达,并分析胃癌患者的临床病理特征及胃癌淋巴结中CK20表达对5年无瘤生存率的影响。结果经免疫组化染色,有9.07%(191/2106)的淋巴结出现CK20阳性表达;有26.67%(32/120)患者的淋巴结中出现CK20阳性表达,其中11例(9.17%)为微转移,21例(17.50%)为孤立肿瘤细胞巢(ITC)。术后随访24～121个月(平均66.35个月)。淋巴结中CK20阴性表达、ITC和微转移的患者,5年无瘤生存率分别为87.4%、78.3%和40.9%。5年无瘤生存率在淋巴结CK20出现微转移者中明显低于CK20阴性表达者(P=0.000)和以ITC为特征者(P=0.046),而仅以ITC为特征者与CK20阴性表达者间比较,差异无统计学意义(P=0.253)。淋巴结中CK20阳性表达与胃癌患者的肿瘤直径(P=0.011)、浸润胃壁深度(P=0.043)和是否有淋巴管浸润(P=0.002)有关。所有临床病理因素对5年无瘤生存率均无明显影响(P>0.05)。11例胃癌患者被检测出微转移,应划分为pN1(Mi)期,本组重新分期率9.17%。而88例胃癌患者淋巴结CK20(-)和21例表达为ITC,分别被记为pN0(i-)和pN0(i+),不建议重新分期,仍为pN0期。结论对于pT1～3N0期胃癌,若淋巴结中检测出微转移,其预后较差,术后5年无瘤生存率较低,建议术后应予以积极的辅助治疗。Objective To investigate the lymph node micrometastasis and its clinicopathologic features on 5-year disease free survival rate for patients with pT1-3N0 gastric cancer.Methods One hundred and twenty patients with stage pT1-3N0 gastric tumors were included,and 2 106 lymph nodes were harvested and examined in all the specimens.There were 9-28 lymph nodes with average 18 lymph nodes from each patient.All the lymph nodes were negative by HE staining.The CK20 expression of lymph nodes was tested by immunohistochemistry.The relationships between clinicopathologic features or CK positive expression and 5-year disease free survival were analyzed.Results The positive expression rate of CK20 was 9.07%（191/2 106）in lymph nodes and 26.67%（32/120）in patients with pT1-3N0 gastric cancer by immunohistochemistry.Eleven cases were with micriometastasis,21 cases were isolated tumor cells（ITC）.The average postoperative follow-up was 66.35（range 24-121）months.Five-year disease free survival rates were 87.4%,78.3%,and 40.9% for the lymph node negative,ITC,and micrometastasis groups,respectively.Five-year disease free survival rate in the micrometastasis group was lower than that in the lymph node negative group（P=0.000）and ITC group（P=0.046）.However,there was no significant difference between the lymph node negative group and ITC group（P=0.253）.Multivariate analysis identified tumor diameter（P=0.011）,depth of tumor invasion（P=0.043）,and lymphatic vessel invasion（P=0.002）were related with CK20 positive expression.There was no significant relationship between the pathologic parameters and the 5-year disease free survival rates.Lymph node micrometastasis of gastric cancer was detected in 11 patients who should belong to stage pN1（Mi）,the restage rate was 9.17%.While the lymph node negative（88 patients）and ITC（21 patients）were recorded pN0（i-）and pN0（i＋）,respectively,and were not recommended restage（stage pN0）.Conclusion Patients with stage pT1-3N0 gastric cancer and micr

关 键 词：胃癌 预后 淋巴结微转移 病理因素 

分 类 号：R735.2[医药卫生—肿瘤]