Clinical significance of lymph node micrometastasis in gallbladder carcinoma

胆囊癌淋巴结微转移的临床意义

• 批准号: 11671213
• 负责人: SHIRAI Yoshio
• 金额: $ 1.22万
• 依托单位: Niigata University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 1999
• 资助国家: 日本
• 起止时间: 1999 至 2000
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-11671213/
• 关键词: gallbladder carcinoma; early gallbladder carcinoma; lymph node micrometastasis; anticytokeratin antibody; immunohistochemistry; lymph node metastasis; radical surgery; prognosis

BACKGROUND.This retrospective study was intended to define the clinical significance of lymph node micrometastasis in gallbladder carcinoma(GBC).METHODS.A total of 1136 regional lymph nodes taken from 63 consecutive patients undergoing radical resection were examined histologically. Micrometastasis was defined as a metastasis missed on routine histologic examination with hematoxylin and eosin but detected by immunohistochemical examination with an antibody against cytokeratins 8 and 18.RESULTS.None of 9 patients(0%)with pTl disease and 19 of 54 patients(35%)with pT2-4 disease had nodal micrometastasis. Univariate analysis identified nodal micrometastasis, type of radical resection, M classification, pT classification, perineural invasion, pTNM stage, timing of radical resection, lymphatic vessel invasion, and pN classification as significant variables. Multivariate analysis revealed that nodal micrometastasis(P=.0003)and type of radical resection(P=.0044)were independent prognostic factors. Nodal micrometastasis affected survival adversely, despite the absence(P=.0002)or presence(P<.0001)of overt nodal metastasis. Nodal micrometastasis correlated significantly with invasive characteristics : lymphatic vessel invasion, perineural invasion, and distant metastasis.CONCLUSIONS.Lymph node micrometastasis is the strongest independent predictor of worse survival regardless of the overt nodal status and may indicate aggressive tumor biology among patients undergoing curative resection for GBC.

背景：本回顾性研究旨在明确胆囊癌淋巴结微转移的临床意义。方法：对63例连续行根治性切除术患者的1136个区域淋巴结进行组织学检查。微转移定义为常规苏木精-伊红组织学检查未发现，但免疫组化检测细胞角蛋白8和18.18抗体发现的转移。9例pT 1患者（0%）和19例pT 2 -4患者（35%）无淋巴结微转移。单因素分析确定淋巴结微转移、根治性切除术类型、M分类、pT分类、神经周围浸润、pTNM分期、根治性切除术时机、淋巴管浸润和pN分类为显著变量。多因素分析显示，淋巴结微转移（P= 0.0003）和根治性切除术的类型（P= 0.0044）是独立的预后因素。淋巴结微转移对生存率有不利影响，无论是否存在明显的淋巴结转移（P = 0.0002）。淋巴结微转移与浸润性特征显著相关：淋巴管浸润、神经周围浸润和远处转移。结论：淋巴结微转移是最强的独立预测因子，无论淋巴结状态如何，都是生存率较差的独立预测因子，并可能表明GBC根治性切除患者的肿瘤生物学具有侵袭性。

项目成果

Naoyuki Yokoyama: "Immunohistochemical detection of lymph node micrometastases from gallbladder carcinoma using monoclonal anticytokeratin antibody"Cancer. 85・7. 1465-1469 (1999)

Naoyuki Yokoyama：“使用单克隆抗细胞角蛋白抗体对胆囊癌淋巴结微转移进行免疫组织化学检测”癌症 85・7（1999）。

Naoyuki Yokoyama: "Immunohistochemical detection of lymph node micrometastases from gallbladder carcinoma using monoclonal anticytokeratin antibody"Cancer. 85-7. 1465-1469 (1999)

Naoyuki Yokoyama：“使用单克隆抗细胞角蛋白抗体对胆囊癌淋巴结微转移进行免疫组织化学检测”癌症。

Shigenori Nagakura: "Clinical significance of lymph node micrometastasis in gallbladder carcinoma"Surgery. (in press). (2001)

Shigenori Nagakura：“胆囊癌淋巴结微转移的临床意义”手术。

Toshifumi Wakai: "Early gallbladder carcinoma does not warrant radical resection"The British Journal of Surgery. (in press). (2001)

Toshifumi Wakai：“早期胆囊癌不需要根治性切除”《英国外科杂志》。

Toshifumi Wakai: "Early gallbladder carcinoma does not warrant radical resection"The British Journal of Surgery. (発表予定). (2001)

Toshifumi Wakai：“早期胆囊癌不需要根治性切除”，英国外科杂志（2001 年）。