胃窦部癌No.12b淋巴结转移的临床病理因素及临床意义研究  

Clinicopathological factors and clinical significance of No.12b lymph node metastasis in gastric antrum cancer

作　　者：张宝 郑国良[1] 张勇[2] 赵岩[1] 朱海涛[1] 张涛[1] 刘勇[1] 郑志超[1] Zhang Bao;Zheng Guoliang;Zhang Yong;Zhao Yan;Zhu Haitao;Zhang Tao;Liu Yong;Zheng Zhichao(Department of Gastric Surgery,Liaoning Cancer Hospital&Institute,Cancer Hospital of Dalian University of Technology,Cancer Hospital of China Medical University,Shenyang 110042,China;Department of Pathology,Liaoning Cancer Hospital&Institute,Cancer Hospital of Dalian University of Technology,Cancer Hospital of China Medical University,Shenyang 110042,China)

机构地区：[1]辽宁省肿瘤医院大连理工大学附属肿瘤医院中国医科大学肿瘤医院胃外科,沈阳110042 [2]辽宁省肿瘤医院大连理工大学附属肿瘤医院中国医科大学肿瘤医院病理科,沈阳110042

出　　处：《中华胃肠外科杂志》2024年第2期167-174,共8页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨胃窦部癌No.12b淋巴结(微)转移的相关临床病理因素及其清扫的临床意义。方法本研究采用回顾性队列研究方法。收集2007年1月至2012年12月期间,于辽宁省肿瘤医院胃外科接受胃癌根治术(至少D2根治范围)+No.12b淋巴结清扫、无远处转移、随访资料完整且未接受术前抗肿瘤治疗或伴有其他恶性肿瘤(史)的242例胃腺癌病例资料。鉴于胃癌淋巴结存在微转移的可能性,本研究应用抗体细胞角蛋白(CK)8/18进行免疫组织化学(免疫组化)检测患者No.12b淋巴结微转移情况。若患者苏木精-伊红(HE)染色和(或)CK8/18免疫组化结果为No.12b阳性,判定为No.12b(微)转移,纳入No.12b阳性组;反之则纳入No.12b阴性组。观察No.12b(微)转移情况,比较No.12b阳性和阴性两组患者的临床病理特征和5年无复发生存(RFS)情况,并进行相关危险因素分析。结果传统HE染色显示,242例胃腺癌患者中No.12b淋巴结阳性15例,阴性227例。共计241枚阴性No.12b淋巴结,免疫组化检测发现,其中7枚为No.12b淋巴结微转移阳性,微转移淋巴结检出率2.9%(7/241),且7枚分布于阴性病例中的不同病例,微转移率为3.1%(7/227)。据微转移结果进行重新分组:No.12b阳性组22例,占9.1%(22/242);No.12b阴性组220例,占90.9%(220/242)。多因素分析显示,No.12b淋巴结(微)转移与胃壁浆膜受侵越严重(HR=3.873,95%CI:1.676~21.643,P=0.006)、T3分期(HR=1.615,95%CI:1.113~1.867,P=0.045)、N分期越高(HR=1.768,95%CI:1.187~5.654,P=0.019)、TNM分期中Ⅲ期(HR=2.129,95%CI:1.102~3.475,P=0.046)以及No.1、No.8a、No.12a淋巴结转移有关(HR=0.451,95%CI:0.121~0.552,P=0.035;HR=0.645,95%CI:0.071~0.886,P=0.032;HR=1.512,95%CI:1.381~2.100,P=0.029)。生存分析显示,与No.12b阴性组相比,No.12b阳性组患者的5年RFS更差(18.2%比34.5%,P<0.001)。其中,原发肿瘤的分化越差(HR=0.528,95%CI:0.288~0.969,P=0.039)、浆膜受侵越严重(HR=1.262,95%CI:1.039~1.534,P=0.019)、T分期、N分期和Objective To investigate the clinicopathological factors and clinical significance of(micro)metastasis in No.12b lymph node in patients with gastric antrum cancer.Methods This was a retrospective cohort study of data of 242 patients with gastric adenocarcinoma without distant metastasis,complete follow-up data,and no preoperative anti-tumor therapy or history of other malignancies.All study patients had undergone radical gastrectomy(at least D2 radical range)+No.12b lymph node dissection in the Department of Gastric Surgery of Liaoning Cancer Hospital from January 2007 to December 2012.Immunohistochemical staining with antibody CK8/18 was used to detect micrometastasis to lymph nodes.Patients with positive findings on hematoxylin and eosin stained specimens and/or CK8/18 positivity in No.12b lymph node were diagnosed as having No.12b(micro)metastasis and included in the No.12b positive group.All other patients were classified as 12b negative.We investigated the impact of No.12b(micro)metastasis by comparing the clinicopathological characteristics and recurrence free survival(RFS)of these two groups of patients and subjecting possible risk factors to statistical analysis.Results Traditional hematoxylin-eosin staining showed that 15/242 patients were positive for No.12b lymph nodes and 227 were negative.A total of 241 negative No.12b lymph nodes were detected.Immunohistochemical testing revealed that seven of these 241 No.12b lymph nodes(2.9%)were positive for micrometastasis.A further seven positive nodes were identified among the 227 nodes(3.1%)that had been evaluated as negative on hematoxylin–eosin-stained sections.Thus,22/242 patients'(9.1%)No.12b nodes were positive for micrometastases,the remaining 220(90.9%)being negative.Factor analysis showed that No.12b lymph node(micro)metastasis is associated with more severe invasion of the gastric serosa(HR=3.873,95%CI:1.676−21.643,P=0.006),T3 stage(HR=1.615,95%CI:1.113−1.867,P=0.045),higher N stage(HR=1.768,95%CI:1.187−5.654,P=0.019),phase III of TNM stage(H

关 键 词：胃肿瘤 胃窦部 淋巴结清扫 第12b组淋巴结 微转移 细胞角蛋白8/18 预后 

分 类 号：R735.2[医药卫生—肿瘤]