Clinical significance of lymph node micrometastasis in ampullary carcinoma
Clinical significance of lymph node micrometastasis in ampullary carcinoma
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DOI：
10.1007/s00268-005-7985-8
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发表时间：
2006-06-01
影响因子：
2.6
通讯作者：
Hatakeyama, Katsuyoshi
中科院分区：
文献类型：
--
作者：
Sakata, Eiko;Shirai, Yoshio;Hatakeyama, Katsuyoshi
背景：本研究旨在阐明壶腹癌淋巴结微转移的临床意义。材料和方法：对50例壶腹癌患者行胰十二指肠切除加区域淋巴清扫。共有1,283个区域淋巴结(中位数，每个患者25个)接受了组织学检查，以确定是否有转移。临床转移定义为常规组织学检查中苏木精-伊红染色发现的转移。微转移定义为首次用细胞角蛋白7和细胞角蛋白8抗体免疫组织化学检测的转移。中位随访时间为119个月。结果：27例患者的90个淋巴结中有明显的转移。12例患者的33个淋巴结微转移阳性，均有明显的淋巴结转移。有淋巴结微转移的患者有明显转移的淋巴结数目(中位数，3.5%)高于无转移的患者(中位数，0；P&0.001)。在有结节微转移的患者中，远处转移(肠系膜上转移和腹主动脉旁转移)的比例更高(P=0.001和P=0.038)。单因素分析(P<；0.0001)和多因素分析(相对危险度，5.085；P=0.007)表明，淋巴结微转移是一个很强的独立预后因素。在27例有明显淋巴结转移的患者中，有淋巴结微转移患者的术后转归(中位生存期为11个月)明显低于无转移者(中位生存期为63个月；P=0.0009)。结论：免疫组织化学方法检测到的淋巴结微转移提示壶腹癌患者有明显的淋巴转移，对患者的生存有不利影响。
Background: This study aimed to clarify the clinical significance of lymph node micrometastasis in ampullary carcinoma.Materials and Methods: Pancreaticoduodenectomy with regional lymphadenectomy was performed for 50 consecutive patients with ampullary carcinoma. A total of 1,283 regional lymph nodes (median, 25 per patient) were examined histologically for metastases. Overt metastasis was defined as metastasis detected during routine histologic examination with hematoxylin and eosin. Micrometastasis was defined as metastasis first detected by immunohistochemistry with an antibody against cytokeratins 7 and 8. The median follow-up period was 119 months after resection.Results: Overt metastasis was positive in 90 lymph nodes from 27 patients. Micrometastasis was positive in 33 lymph nodes from 12 patients, all of whom also had overt nodal metastases. Patients with nodal micrometastasis had a larger number of lymph nodes with overt metastasis (median, 3.5) than those without (median, 0; P < 0.001). Overt metastasis to distant nodes (superior mesenteric nodes, para-aortic nodes) was more frequent (P = 0.001 and P = 0.038, respectively) in patients with nodal micrometastasis. Nodal micrometastasis was found to be a strong independent prognostic factor on univariate (P < 0.0001) and multivariate (relative risk, 5.085; P = 0.007) analyses. From among the 27 patients with overt nodal metastasis, the outcome after resection was significantly worse in the patients with nodal micrometastasis (median survival time of 11 months) than in those without (median survival time of 63 months; P = 0.0009).Conclusions: Immunohistochemically detected lymph node micrometastasis indicates intensive lymphatic spread, and thus adversely affects the survival of patients with ampullary carcinoma.