Comparative detection of lymph node micrometastases of stage II colorectal cancer by reverse transcriptase polymerase chain reaction and immunohistochemistry
Comparative detection of lymph node micrometastases of stage II colorectal cancer by reverse transcriptase polymerase chain reaction and immunohistochemistry
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DOI：
10.1200/jco.2002.10.023
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发表时间：
2002-10-15
影响因子：
45.3
通讯作者：
Monden, M
中科院分区：
文献类型：
--
作者：
Noura, S;Yamamoto, H;Monden, M
目的：关于淋巴结阴性结直肠癌（CRC）患者淋巴结（LN）微转移的临床意义，已有不一致的结论。我们在同一患者中进行了一项使用抗细胞角蛋白抗体免疫组化（IHC）和癌胚抗原（CEA）特异性逆转录聚合酶链反应（PT-PCR）检测微转移的比较研究，试图更接近其临床应用。从1988年至1996年接受根治性手术的84例If期患者中选择了64例CRC患者，石蜡包埋LN标本中的RNA质量良好。我们研究了每种方法和预后之间的关联存在微转移，结果：在19（29.6%）的64例患者通过RT-PCR和35（54.7%）的64例患者通过IHC检测到微转移。通过RT-PCR分析，CEA mRNA阳性条带的患者在无病生存期和总生存期方面的预后显著差于RT-PCR阴性的患者（分别为P = 0.027和0.015）。通过免疫组化分析，微转移的存在并不能预测患者的无病生存期或总生存期。在各种临床或病理因素中，肿瘤生长特征的浸润模式与较短的无病生存期显著相关。通过多因素、考克斯回归分析，RT-PCR检测的微转移和克罗恩样淋巴样反应均为独立的预后因素。结论：RT-PCR检测的微转移，而不是IHC，可能具有临床价值，在确定患者谁可能是在高风险的CRC复发，因此谁可能受益于系统的辅助治疗。
Purpose : Inconsistent conclusions have been drawn about the clinical significance of micrometastases in lymph nodes (LNs) of node-negative colorectal cancer (CRC) patients. We performed a comparative study of detection of micrometastases using immunohistochemistry (IHC) by anti-cytokeratin antibody and carcinoembryonic antigen (CEA)-specific reverse-transcriptase polymerase chain reaction (PT-PCR) in the same patients, in an attempt to move closer to their clinical application.Patients and Methods: Sixty-four CRC patients, with RNA of good quality available from paraffin-embedded LN specimens, were selected from 84 stage If patients who underwent curative surgery between 1988 and 1996. We investigated associations between the presence of micrometastases by each method and prognosis.Results: Micrometastases were detected in 19 (29.6%) of 64 patients by RT-PCR and in 35 (54.7%) of 64 patients by IHC. By RT-PCR analysis, patients exhibiting a positive band for CEA mRNA had a significantly worse prognosis than those who were RT-PCR-negative, with respect to both disease-free and overall survival (P =.027 and .015, respectively). By IHC analysis, the presence of micrometastasis did not predict patient outcome in terms of either disease-free or overall survival. infiltrating pattern of tumor growth characteristic was significantly associated with shorter disease-free survival among various clinical or pathologic factors. By multivariate, Cox regression analysis, micrometastasis detected by RT-PCR and the Crohn's-like lymphoid reaction were both independent prognostic factors.Conclusion: Micrometastases detected by RT-PCR, but not IHC, may be of clinical value in identifying patients who may be at high risk for recurrence of CRC and who are therefore likely to benefit from systemic adjuvant therapy.