摘要
目的检测非小细胞肺癌(NSCLC)根治术后常规病理诊断转移区域淋巴结中微小转移的发生规律,研究微小转移对临床分期、生存率等的影响。方法经根治术后常规病理证实为T1～T4N0～N1M0期NSCLC 107例,用广谱抗细胞角蛋白抗体AE1/AE3行Envision^(TM)二步法检测,并设阴性、阳性及空白对照。结果判断标准为≥1个细胞的细胞膜或细胞浆出现棕黄色为染色阳性,且细胞形态有恶性特征,即为区域淋巴结微小转移。设肺门淋巴结有微小转移灶可调整分期为pCK-N1期,纵隔淋巴结则为pCK-N2期。分析微小转移病例的中位生存期和1、3、5年生存率及其与临床分期的关系。结果NSCLC中微小转移阳性率为29.9%,其中p-Ⅰ、p-Ⅱ、p-Ⅲ期的分别为27%(21/78)、30%(7/23)、67%(4/6)。病理分期的分层分析显示,非微小转移病例1、3、5年生存率及中位生存期较微小转移组明显延长。将p-Ⅰ～Ⅱ期病例发生纵隔淋巴结微小转移的调整为pCK-ⅢA期,与无微小转移的p-Ⅰ～Ⅱ期病例1、3、5年生存率和中位生存期比较显著下降。将p-ⅠB期肺门淋巴结微小转移者调整为pCK-ⅡB期,与无微小转移的p-ⅠB期生存率比较也有明显减低趋势。将pCK-ⅢA期与p-Ⅲ期、pCK-ⅡB期与无微小转移的p-ⅡB期的长期生存比较无差异。结论NSCLC淋巴结微小转移可能随病情进展检出率增加,淋巴结微小转移是影响长期生存的不利因素,提示pCK-N1可能会等同于p-N1,pCK-N2可能会等同于p-N2,对现有的UICC分期产生影响。
Objective To detect cytokeratin in routine pathology negative regional lymph nodes postoperatively in non-small cell lung carcinoma （NSCLC）, To investigate the relationship of lymph node micrometastasis in P-TNM stages NSCLC and survival rates. Methods From Jan, 1996 to Dec. 2003, 107 paraffin-embedded specimens of T1-T4N0-N1M0 NSCLC patients were collected, Anti-cytokeratin（CK） an- tibody AE1/AE3 was applied to detect cytokeratin with EnvisionTM method in routine pathological negative region lymph nodes in NSCLC, and selected negative control, positive control and blank control, The pulmonary hilar lymph node micrometastasis was upward regulated with stage pCK-N1, mediastinal lymph node micrometastatsis was upward regulated with stage pCK-N2. The result applied to SPSS11.0 software to process, Results The CK positive rate was 29.9% in all the patients. The CK positive rate was 27% （21/78）, 30% （7/23）, 67% （4/6）in stage p- Ⅰ , p-Ⅱ and p-Ⅲ, respectively. All these data showed the tendency by which detectable rate increased and was accompanied by disease progress. Comparing the annual survival rate and median survival time of the non-micrometastasis group with the micrometastasis group in two groups, the survival rate difference was statistically significant. Comparing the annual survival rate and median survival time in pCK-Ⅲ A stage with p- Ⅰ -Ⅱ stage, pCK-Ⅲ A stage annual survival rate and median survival time was significantly different（ P =0.020）. Similarly, comparing the survival rate in pCK- Ⅱ B stage with p- Ⅰ B stage, pCK- Ⅱ B stage survival rate was significantly different（ P =0. 059）. Comparing the survival time of pCK- ⅢA stage with p-Ⅲ stage, pCK- Ⅱ B stage, with p- Ⅱ B stage, euther survival time difference was statistically significant （P =0. 838,0.518）. Conclusions The rate of positive cytokeratin increase is accompanied by the disease progress in NSCLC. Positive cytokeratin has disadvantagious prognosis. It is showed that pCK-N1 may be eq
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2007年第4期246-249,共4页
Chinese Journal of Radiation Oncology
关键词
肺肿瘤
肿瘤微转移
淋巴结
细胞角蛋白
生存率
临床分期
Lung neoplasms
Neoplasms micrometastasis, lymph node
Cytokeratin
Survival rate
Clinical stage
