The significance of immunohistochemically demonstrated nodal micrometastases in patients with squamous cell carcinoma of the head and neck
The significance of immunohistochemically demonstrated nodal micrometastases in patients with squamous cell carcinoma of the head and neck
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DOI：
10.1097/00005537-200211000-00011
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发表时间：
2002-11-01
期刊：
影响因子：
2.6
通讯作者：
Smith, RV
中科院分区：
文献类型：
--
作者：
Rhee, D;Wenig, BM;Smith, RV
目的/假设：头颈部原发性鳞状细胞癌患者发生隐匿性淋巴结转移的风险相对较高。这些转移灶的病理学证明可能很困难，检测此类隐性转移灶可能会发现早期复发风险增加或生存率降低的患者。免疫组化可用于鉴别常规（H&E）组织学检查可能遗漏的隐匿性转移。本研究的目的是确定在头颈部鳞状细胞癌中，经化学鉴定的微转移的患病率和预后意义。研究设计：回顾性分析无转移性疾病证据的颈清扫标本。研究方法：对10例头颈部鳞状细胞癌患者进行颈淋巴结清扫，无常规组织学证据表明淋巴结转移，随后用单克隆抗体混合物AE 1/AE 3对细胞角蛋白进行染色，以检测微转移。结果10例患者中5例在淋巴结中发现隐匿性微转移。原发肿瘤的部位或T分期与隐匿性转移瘤的存在之间没有关联。发现有隐匿性转移的5例患者中有3例发生颈部复发，而无微转移证据的5例患者中只有1例发生区域复发。患者生存率无显著差异。结论.转移性肿瘤细胞经常存在于淋巴结中，即使在通过常规方法没有淋巴结转移的组织学证据的患者中也是如此。微转移的存在可能会增加患者的复发风险，并可能表明预后较差。这些隐匿性转移的真正临床意义将通过长期随访来确定。
Objectives/Hypothesis: Patients with primary squamous cell carcinoma of the head and neck have a relatively high risk of occult lymph node metastases. Pathological demonstration of these metastases may be difficult, and the detection of such occult metastases may identify patients who are at an increased risk for early recurrence or reduced survival. Immunohistochemistry may be applied in the identification of occult metastases that may be missed on routine (H&E) histological examination. The aim of the study is to determine the prevalence and prognostic significance of immunohistochemically identified micrometastases in squamous cell carcinoma of the head and neck. Study Design: A retrospective analysis of neck dissection specimens having no evidence of metastatic disease. Methods: Lymph nodes from neck dissections performed on 10 patients with squamous cell carcinoma of the head and neck without conventional histological evidence of nodal metastases were subsequently stained for cytokeratins by the monoclonal antibody cocktail AE1/AE3 to detect micrometastases. Results. Occult micrometastases were found in the lymph nodes 5 of 10 patients examined. There was no association between the site of primary tumor, or T-tage, and the presence of occult metastases. Three of five patients found to have occult metastases developed recurrence in the neck, whereas only one of five patients with no evidence of micrometastases had regional recurrence. There was no significant discrepancy in the patient survival rate. Conclusions. Metastatic tumor cells are frequently present in lymph nodes, even in patients without histological evidence of nodal metastases by conventional methods. The presence of micrometastases may identify patients at increased risk for recurrence and may indicate poorer prognosis. The true clinical significance of these occult metastases will be determined by a long-term follow-up.