喉癌颈淋巴结增生性滤泡反应分型及其意义  

Significance of Classification of Hyperplastic Follicular Reaction of Cervical Lymph Nodes in Laryngeal Carcinoma

作　　者：徐晋[1] 张杰武[2] 宁晓明[3] 徐玉东[4] 王荣华[5] 贾深汕[2] 

机构地区：[1]哈尔滨医科大学基础医学院生物教研室,哈尔滨市150086 [2]哈尔滨医科大学第三临床医学院头颈外科 [3]哈尔滨医科大学第三临床医学院病理科 [4]哈尔滨医科大学解剖教研室 [5]哈尔滨医科大学组织胚胎教研室

出　　处：《中国肿瘤临床》2002年第9期613-615,629,共4页Chinese Journal of Clinical Oncology

基　　金：黑龙江省九五攻关项目基金资助(编号:GOOGCI190501)

摘　　要：目的:探讨肿瘤引流淋巴结中增生性滤泡反应在抗肿瘤免疫中的作用。方法:47例喉癌患者的157枚淋巴结标本经重新制备,用抗CD45RO和抗CD20单克隆抗体免疫组化染色,对这些淋巴结中的滤泡反应进行分型研究。结果:滤泡反应可以分为两型:在生发中心的中央区域有大量T淋巴细胞聚集的滤泡归为T细胞增生型,平均密度为(260±29)个/mm2;T淋巴细胞在生发中心散在分布者归为T细胞非增生型,平均密度为(58±24)个/mm2;两组密度差异极显著(P<0.001)。19例具有T细胞增生型滤泡反应的患者比28例T细胞非增生型患者有明显较高的5年生存率(P<0.01)和较低的淋巴结转移率(P<0.05)。结论:肿瘤引流淋巴结的滤泡反应类型对喉癌患者的长期生存有明显的影响。具有T细胞增生型滤泡反应的患者预后良好,而具有T细胞非增生型滤泡反应的患者则预后不良。Objective:To study the role of hyperplastic fol li cular reaction in defense a-gainst tumor,which is reflected as histologic chan ges in lymph nodes draining the tumor.Methods:One hundred and fifty-seven lym ph nodes obtained from elective lymphadenectomy in47cases of laryngeal squamo us cell carcinoma were examined to assess the immune response ac-cording to im munohistochemical classification of follicular reaction using monoclonel antibod ies a-gainst CD 45 RO and CD 20 .Results:The follicular reaction of lymph nodes was classified into one of the following immunohistochemical types:T cell increasing type and T cell decr easing type.The T cell increasing type follicles contained large amounts of T l ymphocytes which gathered mainly at the centre region of germinal centre,with a n average density of26029/mm 2 ,and the T cell decreasing type follicles contained less amount of T lymph ocytes which were dispersed over germinal centre,with an average density of58 24/mm 2 .The differences in density of T lympho-cytes in the centre region of germ inal centres between these two types were significant (P<0.001).Ninete en cases who possessed T cell increasing type follicular reaction had significan t higher five-year survival rate(P<0.01)and lower lymph node metastasis rate(P<0.05)than those who pos-sessed T cell decreasing type reaction. Conclusion:The immunohistochemical classification of fol-licular reaction in d raining lymph nodes significantly influences long-term survival after curative surgery for patients with laryngeal squamous cell carcinoma.The patients possessed T cell increas-ing type follicular respo nse can get a favourable prognosis,but those possessed T cell decreasing type follicular reaction may be interrelated with a bad prognosis.

关 键 词：喉癌 颈淋巴结 增生性滤泡反应 预后 临床分型 免疫组织化学 

分 类 号：R739.65[医药卫生—肿瘤]