Occult lymph node metastases detected by cytokeratin immunohistochemistry predict recurrence in node-negative endometrial cancer
Occult lymph node metastases detected by cytokeratin immunohistochemistry predict recurrence in node-negative endometrial cancer
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DOI：
10.1006/gyno.2000.6067
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发表时间：
2001-02-01
影响因子：
4.7
通讯作者：
Kawai, M
中科院分区：
文献类型：
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作者：
Yabushita, H;Shimazu, M;Kawai, M
Objective.即使在早期子宫内膜癌的根治性切除术后，一些患者也会因复发而死亡。我们认为这些患者在诊断时可能有隐匿性淋巴结转移。为了明确子宫内膜癌的隐匿性转移，回顾性分析了子宫内膜癌患者淋巴结中细胞角蛋白表达的临床病理意义。我们检查了46例子宫内膜癌患者的304个盆腔淋巴结和46个原发肿瘤，其中36例为I期疾病，10例为IIIc期疾病。福尔马林固定石蜡包埋的组织切片进行染色，使用抗细胞角蛋白，CA125，巨噬细胞相关抗原的抗体。切片用苏木精和伊红染色。在10例IIIc期患者中，在所有13个有转移的淋巴结中检测到细胞角蛋白表达，而在66个无转移的淋巴结中也有20个（30.3%）细胞角蛋白表达。在225个未证实转移的淋巴结中，37个（16.4%）观察到细胞角蛋白表达，这些淋巴结来自36例I期疾病中的14例。14例淋巴结表达细胞角蛋白的患者中有5例在盆腔复发，而所有22例淋巴结未证实细胞角蛋白表达的患者均无复发。淋巴结巨噬细胞上同时检测到细胞角蛋白和CA 125。淋巴结中细胞角蛋白的表达与原发肿瘤的淋巴管间隙受累密切相关，但与组织学分级或肌层浸润深度无关。多因素分析确定细胞角蛋白表达是I期子宫内膜癌复发的独立危险因素。细胞角蛋白在淋巴结中的免疫组化表达与未检测到的转移预示着这些淋巴结的隐匿性转移，并且是早期子宫内膜癌复发的危险因素。(C)北京：科学出版社.
Objective. Even after curative resection of early endometrial cancer, some patients die as a result of recurrence. We believe that these patients likely had occult lymph node metastases at the time of diagnosis. In an attempt to identify the responsible occult metastases, the clinicopathological significance of cytokeratin expression in lymph nodes with unconfirmed metastasis was evaluated retrospectively in patients with endometrial carcinoma.Methods. We examined 304 pelvic lymph nodes and 46 primary tumors excised from 46 patients with endometrial cancer, including 36 with Stage I disease and 10 with Stage IIIc disease. Formalin-fixed paraffin-embedded tissue sections were stained immunohistochemically using antibodies against cytokeratin, CA125, and macrophage-related antigen. Sections were also stained with hematoxylin and eosin.Results. In 10 patients with Stage IIIc disease, cytokeratin expression was detected in cells other than the tumor cells in all 13 lymph nodes with metastasis and also in 20 (30.3%) of 66 lymph nodes without metastasis. Cytokeratin expression was observed in 37 (16.4%) of 225 lymph nodes with unconfirmed metastasis, which were obtained from 14 of 36 patients with Stage I disease. Five of fourteen patients with lymph nodes expressing cytokeratin had recurrent disease in the pelvic cavity, while all 22 patients with unconfirmed cytokeratin expression in their lymph nodes showed no recurrence. Cytokeratin and CA125 were detected simultaneously on macrophages in lymph nodes. Cytokeratin expression in lymph nodes was closely related to lymph-vascular space involvement of the primary tumor, but was not related to either histological grade or depth of myometrial invasion. Multivariate analysis identified cytokeratin expression as an independent risk factor for recurrence in Stage I endometrial cancer.Conclusions. The immunohistochemical expression of cytokeratin in lymph nodes with undetected metastases predicts occult metastasis to these nodes and is a risk factor for recurrence in early-stage endometrial cancer. (C) 2001 Academic Press.