Immunohistochemically demonstrated lymph node micrometastasis and prognosis in patients with gallbladder carcinoma
Immunohistochemically demonstrated lymph node micrometastasis and prognosis in patients with gallbladder carcinoma
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DOI：
10.1097/01.sla.0000217675.22495.6f
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发表时间：
2006-07-01
影响因子：
9
通讯作者：
Nimura, Yuji
中科院分区：
文献类型：
--
作者：
Sasaki, Eiji;Nagino, Masato;Nimura, Yuji
目的：探讨免疫组织化学检测的淋巴结微转移是否对晚期胆囊癌（pT2-4 肿瘤）患者的生存产生影响。背景数据摘要：最近已在各种特纳病中评估了免疫组织化学检测的淋巴结微转移的临床意义。然而，很少有报道涉及胆囊癌的这一问题。 方法：对接受根治性切除的 67 例胆囊癌患者（pN0，n = 40；pN1，n = 27）的总共 1476 个淋巴结进行细胞角蛋白 8 和 18 单克隆抗体的免疫染色。结果与临床和病理特征以及患者相关。 结果：67 名患者中的 23 名（34.3%）和 1476 个检查的淋巴结中的 37 名（2.5%）通过免疫组织化学检测到淋巴结微转移。在 37 个淋巴结微转移中，21 个（56.8%）是单细胞事件，其余 16 个是簇状转移。在主动脉旁淋巴结中检测到五个微转移。临床病理学特征显示与淋巴结微转移的存在没有显着相关性。 27 名 pN1 疾病患者的生存率比 40 名 pN0 疾病患者的生存率要差（5 年生存率；22.2% vs. 52.6%，P = 0.0038）。同样，23 名有微转移的患者的生存率比 44 名无微转移的患者要差（5 年生存率；17.4% vs. 52.7%，P = 0.0027）。 28 名没有任何淋巴结受累的患者预后最好，而 11 名同时发生两种类型转移的患者的生存率很差。微转移的级别（单细胞或簇）对油的存活没有影响。 Cox比例风险模型将神经周围侵犯、淋巴结微转移和显微静脉侵犯视为重要的独立预后因素。结论：淋巴结微转移对接受肉眼根治性切除的pN0或pN1胆囊癌患者的生存具有显着影响。建议使用角蛋白免疫染色进行广泛的淋巴结切片，以便对胆囊癌患者进行准确的预后评估。
Objective: To investigate whether immunohistochemically demonstrated lymph node micrometastasis has a survival impact ill patients with advanced gallbladder carcinoma (pT2-4 tumors).Summary Background Data: The clinical significance of immunohistochemically detected lymph node micrometastasis recently has been evaluated in various turners. However, few reports have addressed this issue with regard to gallbladder carcinoma.Methods: A total of 1476 lymph nodes from 67 patients with gallbladder carcinoma (pN0, n = 40; pN1, n = 27) who underwent curative resection were immunostained with monoclonal antibody against cytokeratins 8 and 18. The results were correlated with clinical and pathologic features and with patient survival.Results: Lymph node micrometastases were detected immunohistochemically in 23 (34.3%) of the 67 patients and in 37 (2.5%) of the 1476 nodes examined. Of the 37 nodal micrometastases, 21 (56.8%) were single-cell events, and the remaining 16 were clusters. Five micrometastases were detected in the paraaortic nodes. Clinicopathologic features showed no significant associations with the presence of lymph node micrometastases. Survival was worse in the 27 patients with pN1 disease than in the 40 with pN0 disease (5-year survival; 22.2% vs. 52.6%, P = 0.0038). Similarly, survival was worse in the 23 patients with micrometastasis than in the 44 without micrometastasis (5-year survival; 17.4% vs. 52.7%, P = 0.0027). Twenty-eight patients without any lymph node involvement had the best prognosis, whereas survival for the 11 patients with both types of metastasis was dismal. The grade of micrometastasis (single-cell Or cluster) had no effect oil survival. The Cox proportional hazard model identified perineural invasion, lymph node micrometastasis, and microscopic venous invasion as significant independent prognostic factors.Conclusions: Lymph node micrometastasis has a significant Survival impact in patients with pN0 or pN1 gallbladder carcinoma who underwent macroscopically curative resection. Extensive lymph node sectioning with keratin immunostaining is recommended for accurate prognostic evaluation for patients with gallbladder carcinoma.