Gastric carcinoma: stage migration by immunohistochemically detected lymph node micrometastases
Gastric carcinoma: stage migration by immunohistochemically detected lymph node micrometastases
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DOI：
10.1007/s10120-014-0352-4
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发表时间：
2015-01-01
期刊：
影响因子：
7.4
通讯作者：
Wittekind, Christian
中科院分区：
文献类型：
--
作者：
Jeuck, Theresa L. A.;Wittekind, Christian
免疫组织化学检测到先前pN0分类的胃癌的区域淋巴结微转移已被纳入TNM分期系统。本研究旨在探讨胃癌微转移的发生率及其对分期和预后的影响。纳入95例常规组织学检查为pN0的胃癌患者。所有患者在2006-2010年间接受了胃切除和区域淋巴清扫。共获得2018枚淋巴结(中位数为20枚)，用抗PAN细胞角蛋白抗体(KL1)进行免疫组织化学染色，在95例患者中有16例区域淋巴结微转移。14例患者被微转移阳性的区域淋巴结抢了风头。3例患者的淋巴结中仅有孤立的肿瘤细胞。弥漫性组织学类型(p=0.007)和全胃切除(p=0.007)患者的微转移发生率显著高于非弥漫性组织类型患者(p=0.05)。当孤立的肿瘤细胞也被认为是淋巴结受累时，淋巴结阳性患者的复发率显著高于淋巴结阴性患者和<70岁患者(分别为33.3%和6.7%；p=0.026；n=39)。总体生存分析显示，微转移阳性患者和微转移阴性患者之间没有显著差异。淋巴结阴性的胃癌患者区域淋巴结的免疫组织化学染色导致微转移的检测增加，这对分期系统有重要意义。虽然对生存时间没有影响，但70岁以下淋巴结阳性患者的较高复发率表明了免疫组织化学可检测到的微转移的预后价值。
Immunohistochemically detected micrometastases of the regional lymph nodes in previously pN0-classified gastric cancer have been incorporated in the TNM staging system. This study aims to determine the incidence of such micrometastases in gastric carcinoma and to investigate their impact on stage grouping and prognosis.Ninety-five patients with gastric carcinoma classified as pN0 by conventional histological examination were enrolled. All patients underwent gastric resection with regional lymphadenectomy between 2006 and 2010. A total of 2018 lymph nodes was obtained (median, 20 Lymph nodes) and immunohistostained with anti-pan cytokeratin antibody (KL1).Micrometastases were detected in regional lymph nodes by immunohistostaining in 16 out of all 95 patients. Fourteen patients were upstaged by micrometastasis-positive regional lymph nodes. Three patients demonstrated lymph nodes with isolated tumor cells alone. A significantly higher incidence of micrometastases was observed in patients with diffuse histologic type (p = 0.007) and total gastrectomy (p = 0.007). When isolated tumor cells were also regarded as lymph node involvement, the recurrence rate was significantly higher for node-positive than for node-negative patients and for those younger than 70 years (33.3 and 6.7 %, respectively; p = 0.026; n = 39). Overall survival analysis revealed no significant difference between micrometastasis-positive and micrometastasis-negative patients.Immunohistostaining of regional lymph nodes in node-negative gastric carcinoma patients leads to an increased detection of micrometastases with significant implications for the staging system. Although no impact on survival time was shown, the higher recurrence rate for node-positive patients younger than 70 years indicates a prognostic value of immunohistochemically detectable micrometastases.