FREQUENCY AND DISTRIBUTION OF OCCULT MICROMETASTASES IN LYMPH-NODES OF PATIENTS WITH NON-SMALL-CELL LUNG-CARCINOMA
FREQUENCY AND DISTRIBUTION OF OCCULT MICROMETASTASES IN LYMPH-NODES OF PATIENTS WITH NON-SMALL-CELL LUNG-CARCINOMA
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DOI：
10.1093/jnci/85.6.493
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发表时间：
1993-03-17
影响因子：
10.3
通讯作者：
COCHRAN, AJ
中科院分区：
文献类型：
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作者：
CHEN, ZL;PEREZ, S;COCHRAN, AJ
背景资料：准确判断区域淋巴结有无肿瘤是判断肺癌患者预后的关键。敏感的免疫组织化学技术和特异性单克隆抗体的发展增加了我们在黑色素瘤和乳腺癌中检测淋巴结中的小肿瘤细胞群甚至单个肿瘤细胞的能力，这些细胞在常规染色切片中似乎是无肿瘤的。目的：本回顾性研究旨在评估在非小细胞肺癌区域淋巴结转移的检测中，多克隆抗角蛋白试剂在免疫组化分析中的使用是否比传统组织病理学具有任何优势。方法：对65例非小细胞肺癌患者的区域淋巴结石蜡包埋组织切片进行研究。我们检查了来自60名诊断为局限于肺的疾病患者的588个淋巴结的组织和来自5名诊断为转移到某些淋巴结的患者的72个淋巴结的组织。应用抗生物素蛋白-生物素复合物免疫过氧化物酶技术，将多克隆抗角蛋白抗体应用于淋巴结组织切片。结果如下：在60例患者中，38例（63%）在常规评估中不可见的单个肿瘤细胞和小簇肿瘤细胞（隐匿性微转移）在苏木精-伊红染色切片检查中淋巴结呈阴性。在诊断为淋巴结阳性非小细胞肺癌的5例患者中，常规检查无肿瘤的51个淋巴结中有10%包含转移。转移瘤细胞多位于被膜下或髓窦。含有隐匿性肿瘤细胞的淋巴结是位于肿瘤最近的淋巴结，主要位于支气管周围和肺门位置。隐匿性转移患者的中位生存期（1977天）短于淋巴结不含肿瘤的患者（2456天），但长于淋巴结含有苏木精-伊红染色切片可检测到的转移的患者（927天）。结论：我们的研究结果表明，在非小细胞肺癌患者中，区域淋巴结转移的发生率比以前通过常规组织学方法确定的更高，并且比其他肿瘤类型（如黑色素瘤和乳腺癌）的发生率更高。含义：非小细胞肺癌中隐匿性淋巴结转移的高发生率清楚地表明，如果没有免疫组化，许多患者的疾病分期不足。因此，在临床试验中对淋巴结进行免疫组化评价似乎是必要的。
Background: Accurate assessment of the presence and absence of tumor in the regional lymph nodes is critical in assessment of prognosis for patients with lung cancer. Development of sensitive immunohistochemical techniques and specific monoclonal antibodies has increased our capacity, in melanoma and breast cancer, to detect small groups of tumor cells or even single tumor cells in lymph nodes that appear to be tumor free in conventionally stained sections. Purpose: This retrospective study was designed to assess whether use of a polyclonal antikeratin reagent in immunohistochemical analysis offers any advantage over conventional histopathology in detection of regional lymph node metastases in non-small-cell lung cancer. Methods: Paraffin-embedded tissue sections from regional lymph nodes of 65 patients with non-small-cell lung cancer were studied. We examined tissue from 588 nodes of 60 patients with a diagnosis of disease confined to the lung and from 72 nodes of five patients with a diagnosis of metastasis to some nodes. A polyclonal antikeratin antibody was applied to the lymph node tissue sections, using the avidin-biotin complex immunoperoxidase technique. Results: Single tumor cells and small clusters of tumor cells (occult micrometastases) not visible on routine evaluation were readily detected in 38 (63%) of the 60 patients whose nodes appeared to be negative on examination of hematoxylin-eosin-stained slides. In the five patients with a diagnosis of node-positive non-small-cell lung cancer, rive (10%) of 51 nodes that were tumor free on conventional examination contained metastases. Metastatic tumor cells were most often located in the subcapsular or medullary sinuses. The lymph nodes that contained occult tumor cells were those located nearest to the tumor, mainly in peribronchial and hilar locations. The median survival of patients with occult metastases (1977 days) was shorter than that of patients whose nodes contained no tumor (2456 days) but was longer than that of patients whose nodes contained metastases detectable on hematoxylin-eosin-stained slides (927 days). Conclusions: Our results suggest that, in patients with non-small-cell lung cancer, metastatic involvement of regional lymph nodes is more frequent than was previously determined by the conventional histologic method and substantially more frequent than in other tumor types, such as melanoma and breast cancer. Implications: The high frequency of occult nodal metastases in non-small-cell lung cancer makes it clear that, without immunohistochemistry, disease is understaged in many patients. Therefore, it seems essential that immunohistochemical evaluation of the lymph nodes be undertaken in clinical trials.