病理科医师细致取材对新辅助放化疗直肠癌患者术后淋巴结检测结果的影响  

Effects of meticulousness of pathologists on lymph node harvest after neoadjuvant chemoradiotherapy combined radical resection of patients with rectal cancer

作　　者：赵权权[1] 于志奇 郑建明[3] 傅传刚[1] 于恩达[1] 张卫[1] 孟荣贵[1] 王汉涛[1] 郝立强[1] 王颢[1] ZHAO Quan-quan;YU Zhi-qi;ZHENG Jian-ming;FU Chuan-gang;YU En-da;ZHANG Wei;MENG Rong-gui;WANG Han-tao;HAO Li-qiang;WANG Hao(Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;Department of Thoracic Surgery, No. 306 Hospital of PLA, Beijing 100101, China;Department of Pathology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China)

机构地区：[1]第二军医大学长海医院肛肠外科,上海200433 [2]解放军306医院胸外科,北京100101 [3]第二军医大学长海医院病理科,上海200433

出　　处：《第二军医大学学报》2017年第12期1567-1571,共5页Academic Journal of Second Military Medical University

基　　金：国家自然科学基金(81172307)~~

摘　　要：目的探讨多学科合作后病理科医师细致取材对新辅助放化疗直肠癌患者术后淋巴结检测结果的影响。方法回顾性分析第二军医大学长海医院肛肠外科2005年1月至2014年12月收治的接受新辅助放化疗及根治性手术的191例Ⅰ~Ⅲ期直肠癌患者的临床资料。自2009年1月起与病理科开展直肠癌多学科合作,病理科医师通过细致取材使每例直肠癌患者术后淋巴结检出数量不少于15枚,据此将患者分为常规取材组(46例)和细致取材组(145例)。比较两组患者术后淋巴结的检出数量及阳性率。结果细致取材组患者术后淋巴结的检出数量较常规取材组增加[(13.1±4.9)枚/例vs(9.6±4.0)枚/例,P<0.01],其中≥12枚的比例提高(69.7%vs 33.3%,P<0.01)。常规取材组患者术后阳性淋巴结数量[(1.8±2.9)枚/例vs(1.9±3.8)枚/例,P=0.334]和淋巴结阳性率(50.0%vs38.6%,P=0.172)与细致取材组相比差异均无统计学意义。T0、T1、T2、T3和T4期常规取材组和细致取材组患者的淋巴结阳性率分别为25.0%(1/4)和22.7%(5/22)、0.0%(0/1)和33.3%(1/3)、9.1%(1/11)和25.0%(8/32)、70.0%(21/30)和47.1%(40/85)及0.0%(0/0)和66.7%(2/3),不同T分期之间两组患者的淋巴结阳性率差异无统计学意义(χ~2=4.55,P=0.209)。结论多学科合作后病理科医师细致取材可增加接受新辅助放化疗患者术后淋巴结的检出数量,但并不增加阳性淋巴结的检出数量及淋巴结阳性率。对于接受新辅助放化疗的直肠癌患者建议选择淋巴结辅助检出技术以获得更准确的淋巴结情况。ObjectiveTo investigate the effect of meticulousness of pathologists on the lymph node harvest after radical resection of invasive rectal carcinoma in paients following neoadjuvant chemoradiotherapy.MethodsThe clinical data of191patients with rectal cancer(stageⅠtoⅢ)undergoing radical excision after neoadjuvant chemoradiotherapy in Department of Colorectal Surgery,Changhai Hospital,Second Military Medical University from Jan.2005to Dec.2014were retrospectively analyzed.Since Jan.2009when multidisciplinary cooperation was carried out,pathologists and surgeons suggested that no less than15lymph nodes in single rectal specimen should be found by meticulousness of pathologists,according to which patients were divided into routine sampling group(n=46)and meticulousness group(n=145).The harvest number and positive rate of postoperative lymph nodes were compared between the two groups.ResultsThe lymph node retrieval in the meticulousness group was significantly more than that in the routine sampling group(13.1±4.9vs9.6±4.0,P<0.01),and the percentage of patients with the lymph node harvest equaling or more than12was significantly increased(69.7%vs33.3%,P<0.01).There were no significant differences in the positive node harvest number(1.8±2.9vs1.9±3.8,P=0.334)or positive rate of lymph nodes(50.0%vs38.6%,P=0.172)between the two groups.The positive rate of lymph nodes of patients in T0,T1,T2,T3,and T4stages in the two groups were25.0%(1/4)and22.7%(5/22),0.0%(0/1)and33.3%(1/3),9.1%(1/11)and25.0%(8/32),70.0%(21/30)and47.1%(40/85),and0.0%(0/0)and66.7%(2/3),respectively.There were no significant differences in T stages between the two groups(χ2=4.55,P=0.209).ConclusionThe lymph node harvest number is increased by meticulousness of pathologists after multidisciplinary cooperation,while the positive node harvest number and positive rate of lymph nodes are not increased,suggesting that supplementary measures should be taken to obtain more accurate lymph node status of patients with rectal cancer after neoadjuvant chemoradi

关 键 词：大肠癌 病理科医师 新辅助放化疗 淋巴结 

分 类 号：R604[医药卫生—外科学]