DukesB期大肠癌淋巴结微小转移灶检测的临床研究  

The clinical study on lymphnodes micrometastasis of stage DukesB colorectal cancer

作　　者：张丽萍[1] 鲍云华[2] 吴进冬[2] 李国民[3] 

机构地区：[1]海军总医院放射肿瘤科,北京100037 [2]军事医学科学院附属医院肿瘤科,北京100039 [3]军事医学科学院附属医院病理科,北京100039

出　　处：《癌症》2000年第5期481-489,共9页Chinese Journal of Cancer

摘　　要：目的 :Dukes B期大肠癌患者手术后 5年生存率为 5 3 9%～ 84 9% ,有部分患者 5年内出现局部复发或 /和远处转移。本研究旨在探讨淋巴结微小转移灶 (lymphnodesmicrometastasis,LMM )的表达对评估经手术切除原发肿瘤及肠周淋巴结的Dukes B期大肠癌患者预后的重要性和指导术后治疗的意义。方法 :收集 5 2例Dukes B期大肠癌患者手术切除的淋巴结石蜡标本 ,同时获得这些病例的临床资料及随访 (生存期大于 5年或死亡 )资料 ;实验方法 :以细胞角蛋白单抗 (anti cytokerratinAE1/AE3)为探针 ,采用免疫组化SAP(streptavidin alkalinephosphatase)法检测淋巴结中的LMM。 结果 :测 5 2例Dukes B期大肠癌患者的淋巴结中LMM +组 11例(2 1 15 % ) ,LMM 组 41例 (78 85 % )。在 38例生存期大于 5年的患者中LMM +占 13 2 % (5 / 38,)LMM 占86 8% (33/ 38)。χ2 检验P <0 0 5 ,生存分析log rank检验P <0 0 5 ;说明LMM +组的生存期明显短于LMM 组。本实验中一般因素 (性别、年龄及肿瘤所在部位 )对LMM检测结果的影响不明显 ;统计学处理 ,P >0 0 5。结论 :用免疫组化法检测Dukes B期大肠癌患者经手术切除后肠周淋巴结中的微小转移灶对判断患者预后及指导术后治疗均有意义 ,值得在临床应用。Objective:Patients with DukesB (transmurally invasive, lymph node negative) colorectal cancer have a postoperative 5 year survival rate of about 53 9%to 84 9% It means that part of the patients appears local relapse or/and distant metastasis in the period of 5 years The object is to clinical significance of investigate the lymph node micrometastasis (LMM) for prognosis and postoperative treatment Methods:The paraffin embedded lymph nodes samples from 52 patients were collected The clinical material and follow up information the patients were obtained The immunocytochemical staining method of streptavidin alkaline phosphatase (SAP) was applied to detect the micrometastasis in lymph nodes using the monoclonal antibody AE1/AE3, which is specific for cytokeratin antigens Results:Micrometastases (LMM+) were detcted in 11(21 15%) out of 52 patients There were 13 2%(5/38) LMM+and 86 8%(33/38) micrometastasis negative (LMM ) in 38 patients of more than 5 year survives χ 2 test,P< 0 05 Survive analysis by log rank test, P< 0 05 Micrometastasis in lymph nodes was associated with decreased survival time in patients with DukesB colorectal cancer However, micrometastasis was not affaeted by of the sex, age patient and location of the carcinoma (P >0 05) Conclusions:Micrometastases in lymph nodes in patients with DukesB colorectal cancer obviously influence survival time The detection of micrometasbasis is for guiding postoperative treatment

关 键 词：大肠肿瘤 微小转移灶 细胞角蛋白 Bukes'B期 

分 类 号：R735.34[医药卫生—肿瘤] R73－37[医药卫生—临床医学]