肉眼观肿大淋巴结对Ⅱ期结直肠癌预后的影响及其机制探讨  

Impact of macroscopic enlarged lymph node on stage colorectal cancer prognosis and its potential mechanism

作　　者：范文华[1] 黄子一[1] 方淯靖[1] 万德森[1] 潘志忠[1] 李力人[1] 

机构地区：[1]中山大学肿瘤防治中心结直肠外科,广州510060

出　　处：《中华胃肠外科杂志》2015年第6期558-562,共5页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的：探讨肉眼观肿大淋巴结对Ⅱ期结直肠癌预后的影响及其机制。方法回顾性收集2001年12月至2002年12月中山大学肿瘤防治中心连续收治的行结直肠癌根治术、术后病理证实为Ⅱ期且无系膜淋巴结转移的116例患者的临床资料，所有患者术中均由手术医生通过肉眼观淋巴结有无肿大来判定是否为淋巴结可疑转移，其中肉眼观淋巴结肿大的病例43例，无淋巴结肿大病例73例，比较两组患者的生存率，分析肉眼观肿大淋巴结对Ⅱ期结直肠癌患者预后的影响，并在镜下观察淋巴结的结构。对43例肉眼观淋巴结肿大病例的107枚肿大淋巴结进行免疫组织化学染色。结果全组10年无瘤生存率（DFS）85．3％；肉眼观淋巴结肿大患者10年DFS为75．9％，明显低于淋巴结无肿大患者的89．3％（P＝0．038）。单因素分析结果显示，术前合并症（P＝0．003）、术前癌胚抗原（P＝0．050）、围手术期输血（P＝0．004）、肉眼观肿大淋巴结（P＝0．038）及送检淋巴结（P＝0．016）是影响Ⅱ期结直肠癌患者预后的因素。多因素分析结果显示，肉眼观淋巴结肿大（P＝0．044）、送检淋巴结数目（P＝0．021）及围手术期输血（P＝0．032）是影响Ⅱ期结直肠癌患者预后的独立因素。107枚肿大淋巴结呈反应性增生，其中大体转移1枚，微转移1枚，孤立肿瘤细胞4枚，余101枚未见阳性表达。结论肉眼观肿大淋巴结可能提示Ⅱ期结直肠癌患者预后不良。Objective To evaluate the impact of macroscopic enlarged lymph node on the clinicopathological characteristics of stage Ⅱ colorectal cancer, and to explore the potential mechanism. Methods Clinicopathological data of 116 consecutive patients with stage Ⅱ colorectal cancer, who underwent colorectal radical resection and were identified as stage Ⅱ colorectal cancer without mesenteric metastasis by postoperative pathology , in our department between December 2001 and December 2002 were analyzed retrospectively. All the patients were examined by the surgeons with gross appearance to decide the enlarged lymph nodes as metastasis during operation. There were 43 patients with macroscopic enlarged lymph nodes and 73 without such lymph nodes. Survival rate was compared between the two groups. Impact of macroscopic enlarged lymph node on the prognosis of stage Ⅱcolorectal cancer was analyzed. Structure of macroscopic enlarged lymph node was observed. CK expression in 107 macroscopic enlarged lymph nodes from 43 cases was examined by immunohistochemistry. Results The 10-year disease-free survival（DFS） of the whole group was 83.5%. The 10-year DFS of patients with macroscopic enlarged lymph nodes was 75.9% , which was significantly lower than 89.3%（P=0.038） of patients without macroscopic enlarged lymph nodes. Univariate analysis showed that macroscopical enlarged lymph node （P=0.038）, perioperative blood＆nbsp;transfusion （P=0.004）, number of retrieved lymph nodes （P=0.016）, concomitant disease （P=0.003）, and preoperative serum carcinoembryonic antigen （CEA） level （P=0.050） were related to the prognosis of all the 116 patients. Multivariate analysis showed that macroscopical enlarged lymph node （P=0.044）, number of retrieved lymph nodes （P=0.021）, and perioperative blood transfusion （P=0.032） were independent prognostic factors. Haematoxylin and eosin （HE） staining indicated that enlarged lymph nodes had hyperplasia reaction. Immunohistochemistry showed that among 107

关 键 词：结直肠肿瘤 Ⅱ期 肉眼观肿大淋巴结 微转移 预后 

分 类 号：R735.34[医药卫生—肿瘤]