摘要
目的探究隐匿性肿瘤细胞(OTC)在淋巴结转移阴性(pN0)胃癌患者中的检出率及其对患者预后的影响。方法选取2010年1月至2015年1月浙江金华广福肿瘤医院收治的73例pN0期胃癌患者作为研究对象。采用免疫组织化学方法检测1257枚术中分离淋巴结中OTC的检出率,分析OTC对患者临床病理参数及预后的影响。结果73例患者中有30例(41%)检测出OTC阳性,其中20例检测出微转移(MM),10例仅检测出孤立肿瘤细胞(ITC)。术中共分离1257枚淋巴结,其中90枚淋巴结呈OTC阳性。在20例MM阳性患者中,受累淋巴结数目为70枚,每例患者平均3.5枚。在10例仅有ITC的患者中,受累淋巴结数目为20枚,每例患者平均2.0枚。Cox多因素分析发现,肿瘤直径、分化类型、淋巴管浸润、OTC、MM、ITC均是影响患者总体生存时间的独立危险因素。OTC阳性组的中位生存时间为68个月,其中ITC阳性组为73个月,MM阳性组为63个月,而OTC阴性组为93个月。Log-rank检验结果显示,OTC阴性组患者的生存率显著高于OTC阳性组。进一步的亚组分析结果显示,ITC阳性组及MM阳性组的生存率均显著低于OTC阴性组。结论在部分pN0期胃癌患者的淋巴结中OTC的检出率较高,且OTC对患者的预后有明显不良影响。
Objective An attempt is made in this paper to investigate the detection rate of occult tumor cells(OTC)in patients with pN0 stage gastric carcinoma and its influence on prognosis.Methods A total of 73 patients with pN0 stage gastric carcinoma admitted to Zhejiang Jinhua Guangfu Tumor Hospital from January 2010 to January 2015 were selected as the research objects.Immunohistochemistry methods were used to detect the detection rate of OTC in 1257 intraoperatively separated lymph nodes,and the influence of OTC on the clinicopathological parameters and prognosis of patients was analyzed.Results Of the 73 patients,30(41%)were positive for OTC,20 were positive for micrometastasis(MM),and 10 were only detected for isolated tumor cell(ITC).A total of 1257 lymph nodes were isolated,90 of which were OTC positive.In 20 MM positive patients,the total number of involved lymph nodes was 70,with an average of 3.5 in each patient.In 10 patients with only ITC,the number of involved lymph nodes was 20,and the average number of involved lymph nodes in each patient was 2.0.The Cox multivariate analysis showed that tumor diameter,differentiation type,lymphatic invasion,OTC,MM,and ITC were independent risk factors affecting the overall survival time of patients.The median survival time was 68 months in the OTC positive group,73 months in the ITC positive group,63 months in the MM positive group,and 93 months in the OTC negative group.The Log-rank test demonstrated that the survival rate of the OTC negative group was significantly higher than that of the OTC positive group.The survival rate of the ITC positive group and the MM positive group was significantly lower than that of the OTC negative group.Conclusion The detection rate of OTC in the lymph nodes of some patients with pN0 stage gastric carcinoma is relatively high,and OTC positive has a significant adverse effect on the prognosis of patients.
作者
叶婵娟
吴仲平
陈仲华
YE Chanjuan;WU Zhongping;CHEN Zhonghua(Department of Neurology,Zhejiang Jinhua Guangfu Tumor Hospital,Jinhua 321000,China;Department of Gastroenterology,Zhejiang Jinhua Guangfu Tumrr Hospital,Jinhua 321000,China;Department of Pathology,Zhejiang Jinhua Guangfu Tumor Hospital,Jinhua 321000,China)
出处
《国际消化病杂志》
CAS
2021年第2期118-123,134,共7页
International Journal of Digestive Diseases
关键词
胃癌
隐匿性肿瘤细胞
淋巴结微转移
孤立肿瘤细胞
Gastric carcinoma
Occult tumor cells
Lymph node micrometastasis
Isolated tumor cell
