摘要
目的探讨胃癌淋巴管生成、淋巴管浸润及淋巴结微转移的临床意义。方法免疫组化法检测68例胃癌原发灶中D2-40的表达及其中51例胃癌的791枚淋巴结中CK20和CKpan的表达,结合患者的临床病理特征进行综合分析。结果胃癌HE染色淋巴管浸润(LVI-HE)和D2-40染色淋巴管浸润(LVI-IM)的阳性率分别为66.2%(45/68)和76.5%(52/68),差异无统计学意义(P=0.118)。LVI-IM阳性率与肿瘤浸润深度(P=0.044)、TNM分期(P=0.003)及存在淋巴结转移(P=0.000)有关。68例胃癌平均淋巴管密度(LVD)为(18.19±7.44)个/HP。LVD升高与LVI-HE阳性(P=0.040)、LVI-IM阳性(P=0.001)、静脉浸润(P=0.037)、TNM分期较晚(P=0.020)及存在淋巴结转移(P=0.001)有关系。LVD值≥15个/HP者近期生存率较LVD值≤14个/HP者明显降低(P=0.032)。51例胃癌HE染色和CK(CK20或CKpan)染色检出淋巴结转移率分别为74.5%(38/51)和88.2%(45/51),791枚淋巴结的转移淋巴结检出率由HE染色的32.0%(253/791)提高到CK染色的41.5%(328/791),P<0.001。CKpan的微转移检出率明显高于CK20(P=0.003)。微转移淋巴结数量与肿瘤大小(P=0.001)、LVI-HE(P=0.040)、肿瘤浸润深度(P=0.018)及TNM分期(P=0.012)有关。微转移淋巴结的检出使淋巴结转移站别及TNM分期迁移:7例N0→N1,6例N1→N2,1例N2→N3;4例Ⅰb→Ⅱ,4例Ⅱ→Ⅲa,3例Ⅲa→Ⅲb,1例Ⅲb→Ⅳ。结论D2-40及CK检测在诊断淋巴管浸润和淋巴结微转移上优于HE检查。CK20和CKpan的联合检查有利于发现微转移淋巴结。肿瘤TNM分期越晚,越易发生淋巴结微转移。LVI-IM、LVD及淋巴结微转移三者都与胃癌淋巴结转移有关。LVD值较高者近期生存率较低。
Objective To investigate the clinical meanings of lymphangiogenesis, lymph vessel invasion （LVI） and lymph node （LN） micrometastasis in gastric cancer. Methods The expression of D2-40 in 68 patients with gastric cancer of primary lesion and the expressions of CK20 and （or） CKpan in 791 lymph nodes from 51 cases which were detected by immunohistochemical staining were analyzed, as well as their clinicopathologic profiles. The relationship of lymph vessel density （LVD）, LVI and LN micrometastasis with LN metastasis and other clinicopathologic parameters was analyzed respectively. Results Positive rate of LVI with HE （LVI-HE） and D2-40 （LVI-IM） staining was respectively 66.2% （45/68） and 76.5% （52/68）, P=0. 118. The positive rate of LVI-IM was related to deeper tumor invasion （P=0. 044）, later stage of TNM （P=0.003） and LN metastasis （P=0.000）. Average LVD of 68 cases was （18.19±7.44）/HP. The increment of LVD was significantly associated with LVI-HE positive status （P=0. 040）, LVI-IM positive status （P=0. 001）, venous invasion （P=0. 037）, later stage of TNM （P=0.020） and LN metastasis （P=0.001）. The survival rate of the group sharing ≥15/HP of LVD was significantly lower than that in the group sharing ≤14/HP of LVD in early period of follow-up （P=0. 032）. The incidence of nodal involvement in 51 patients was increased from 74.5% （38/51） by HE staining to 88.2% （45/51） by CK （CK20 or CKpan） immunostaining. The detection rate of metastasized LN was increased from 32.0% （253/791） by HE staining to 41.5% （328/791） by CK immunostaining （P〈0. 001）. The significant difference of LN mierometastasis detection rate between CK20 （8.7% ） and CKpan （12.3% ） was also identified （P = 0.003）. The increased number of LN micrometastasis was related to larger diameter of tumor （P=0. 001 ）, higher LVI-HE positive rate （P=0. 040）, deeper invasion of tumor （P=0. 018） and later stage of TNM （P=0.012）. Both LN
出处
《中国普外基础与临床杂志》
CAS
2008年第12期903-909,共7页
Chinese Journal of Bases and Clinics In General Surgery
基金
上海市卫生局科研基金赞助(编号:034086)~~
