检测淋巴结微转移对贲门癌病理分期的意义  

Clinical significance of lymph node micrometastasis detection in determining the stage of gastric cardia adenocarcinoma

作　　者：张洛 李青 欧阳范献 林志刚 陈成辉 

机构地区：[1]海南省农垦总医院东湖院区普外科,海口570203 [2]海南省农垦总医院肿瘤内科

出　　处：《中华普通外科学文献（电子版）》2013年第5期36-38,共3页Chinese Archives of General Surgery(Electronic Edition)

基　　金：海南省自然科学基金(30860)

摘　　要：目的分析淋巴结微转移在贲门癌病理分期上的临床意义。方法收集2005年1月至2009年12月间海南省农垦总医院行根治性手术的48例PT1-4N0贲门癌患者临床资料,共获取常规病理学检查阴性的淋巴结323枚。采用免疫组织化学方法,用细胞角蛋白19(CK19)单抗和CD44v6单抗对淋巴结进行检测,并结合临床病理资料进行统计学分析。结果共9例(18.75%)14枚淋巴结(4.33%)发现微转移。有9例分期得到提高,重新分期率为18.75%。其中ⅠA→ⅠB期1例,ⅠB→ⅡA期3例,ⅡA→ⅡB期3例,ⅡA→ⅢA期1例,ⅡB→ⅢB期1例。微转移组的临床复发率明显高于无微转移组(66.67%vs 27.78%,χ2=4.752,P=0.029),5年生存率差异有统计学意义(16.67%vs64.71%,P=0.001)。结论免疫组织化学方法可以提高贲门癌患者淋巴结转移的检出率,有助于更准确地进行临床病理分期。Objective To evaluate the significance of lymph node micrometastasis in determining the stage of gastric cardia adenoearcinoma（GCA）. Methods Three hundred and twenty- three lymph nodes from 48 GCA patients with negative lymph node by routine pathological examination were examined immunohistochemieally（IHC） for the lymph nodes micrometastasis using anti-CK19 and anti-CD44v6 monoclonal anti-body. Clinical data were analyzed by statistical methods. Results Micrometastasis was found in 14 lymph nodes （4.33%） from 9 cases （18.75%）. Nine of those patients were up-staged（from stage I A to I B in one patient, stage I B to lI A in three patients, stage ]I A to l]B in three patients, stage ]] A to ]]IA in one patient, stage 11 B to l]I B in one patient）. The rate of restaging was 18.75%. Conclusion IHC assay can increase the detection rate of lymph node metastasis and has a significant impact on the staging of GCA.

关 键 词：贲门癌 淋巴结 微转移 肿瘤分期 

分 类 号：R735.2[医药卫生—肿瘤]