Rapid, quantitative reverse transcriptase-polymerase chain reaction: application to intraoperative molecular detection of occult metastases in esophageal cancer.
Rapid, quantitative reverse transcriptase-polymerase chain reaction: application to intraoperative molecular detection of occult metastases in esophageal cancer.
复制标题
快速定量逆转录聚合酶链式反应：在食管癌隐匿性转移的术中分子检测中的应用。
DOI：
10.1067/mtc.2002.119884
复制
发表时间：
2002
期刊：
影响因子：
--
通讯作者：
Godfrey,TonyE
中科院分区：
文献类型：
--
作者：
Raja,Siva;Luketich,JamesD;Kelly,LoriA;Gooding,WilliamE;Finkelstein,SydneyD;Godfrey,TonyE
我们早期的数据表明，定量逆转录聚合酶链反应可以区分淋巴结阴性癌症患者复发的高风险。本研究的目的是确定一种新的，更快速的定量逆转录酶-聚合酶链反应测定法是否可以在适合于术中决策的时间范围内提供这一信息。采用快速定量逆转录酶技术，对30例组织学确定为淋巴结阴性的食管癌患者的存档淋巴结进行检测，聚合酶链反应测定癌胚抗原信使RNA的表达。我们还对23例患者的37个速冻淋巴结进行了快速定量逆转录聚合酶链反应。23例患者中有11例患有良性食管疾病（阴性对照组）。结果在回顾性分析30例食管癌患者的存档组织中，组织学确定为阴性淋巴结，快速定量逆转录聚合酶链反应预测疾病复发的敏感性和特异性分别为90%和80%，与常规的定量逆转录-聚合酶链反应相比，在冷冻组织分析中，快速定量逆转录聚合酶链反应检测到所有12个组织学确定的阳性淋巴结中的癌胚抗原表达水平显着高于良性淋巴结。对于这12个淋巴结中的2个，术中冰冻切片分析的组织学结果为阴性，N1状态仅在最终病理检查中确定。快速（术中）定量逆转录聚合酶链反应鉴别两个节点为阳性。在14个组织学确定的阴性节点，3个节点1例显示增加癌胚抗原根据快速定量逆转录酶-聚合酶链反应，和这个病人有一个临床recursion.ConclusionsIn我们的研究中，我们能够迅速区分患者与节点阴性食管癌复发的风险很高。在冷冻组织中，快速定量逆转录聚合酶链反应与12例患者中11例的最终病理报告相关。在1例不一致病例中，定量逆转录酶-聚合酶链反应结果为阳性，可能在显微镜下检测到隐匿性转移，因为该患者确实有疾病复发。快速定量逆转录聚合酶链反应检测转移性疾病比术中冰冻切片更敏感。这些数据表明，快速定量逆转录酶-聚合酶链反应可能具有预后作用，并可指导术中决策。
ObjectiveOur earlier data showed that quantitative reverse transcriptase-polymerase chain reaction can discriminate patients with node-negative cancer who are at high risk for recurrence. The objective of this study was to determine whether a new, more rapid quantitative reverse transcriptase-polymerase chain reaction assay could provide this information in a time frame suitable for intraoperative decision making.MethodsWe studied formalin-fixed, archived lymph nodes from 30 patients with histologically determined node-negative esophageal cancer with rapid quantitative reverse transcriptase-polymerase chain reaction to measure expression of carcinoembryonic antigen messenger RNA. We also performed rapid quantitative reverse transcriptase-polymerase chain reaction on 37 snap-frozen lymph nodes from 23 patients. Eleven of the 23 patients had benign esophageal disorders (negative control group). The other 12 had esophageal cancer, 6 with histologically determined positive lymph nodes and 6 with histologically determined negative lymph nodes.ResultsIn the retrospective analysis of archival tissue from 30 patients with esophageal cancer with histologically determined negative lymph nodes, rapid quantitative reverse transcriptase-polymerase chain reaction predicted disease recurrence with a sensitivity and a specificity of 90% and 80%, respectively, and was comparable to conventional quantitative reverse transcriptase-polymerase chain reaction. In the frozen-tissue analysis rapid quantitative reverse transcriptase-polymerase chain reaction detected significantly higher levels of carcinoembryonic antigen expression in all 12 of the histologically determined positive lymph nodes than in the benign nodes. For 2 of these 12 nodes the intraoperative frozen-section analysis had negative histologic results, and N1 status was determined only on final pathologic examination. Rapid (intraoperative) quantitative reverse transcriptase-polymerase chain reaction discriminated both nodes as positive. Among the 14 histologically determined negative nodes, 1 of 3 nodes from 1 patient showed increased carcinoembryonic antigen according to rapid quantitative reverse transcriptase-polymerase chain reaction, and this patient had a clinical recurrence.ConclusionsIn our study we were able to rapidly discriminate patients with node negative-esophageal cancer who had a high risk of recurrence. In frozen tissues rapid quantitative reverse transcriptase-polymerase chain reaction correlated with final pathologic report for 11 of 12 patients. In the 1 discordant case, the quantitative reverse transcriptase-polymerase chain reaction result was positive and may have detected microscopically occult metastasis, because this patient did have disease recurrence. Rapid quantitative reverse transcriptase-polymerase chain reaction was more sensitive than intraoperative frozen sections for detecting metastatic disease. These data suggest that rapid quantitative reverse transcriptase-polymerase chain reaction may have a prognostic role and could guide intraoperative decisions.