Prognostic value of nodal micrometastases in patients with cancer of the gastro-oesophageal junction
Prognostic value of nodal micrometastases in patients with cancer of the gastro-oesophageal junction
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DOI：
10.1016/j.ejso.2004.12.001
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发表时间：
2005-04-01
期刊：
影响因子：
3.8
通讯作者：
Plukker, JT
中科院分区：
文献类型：
--
作者：
Heeren, PAM;Kelder, W;Plukker, JT
目标。本研究的目的是检测星状食道交界区(GEJ)癌患者中免疫组织化学确定的结节微转移的存在及其对预后的影响。1988年1月至2000年12月，148名患者接受了根治性(R0)切除和两野淋巴清扫。常规苏木精-伊红(H-ET-E)检查未发现淋巴结转移(PN0)的60例患者的标本可用于免疫组织化学。(IHC)使用针对细胞角蛋白的抗体AE1/AE3进行分析。所有石蜡包埋材料。经免疫组化H-ET-E检查有无微转移后，由一位病理学家进行连续切片和分析。在最初分期为pN0的60个切除标本中，共有524个淋巴结可用于IHC分析。在524个淋巴结中，126个(24%)被检测到微转移，而60个患者中有18个(30%)被这项技术抢占了舞台。与pN0组相比，有结节受累的IHC患者的无病生存期显著高于pN0组(p<；0.001)。确诊为IHC的微转移患者的存活率与H-ET-E阳性淋巴结者相当。在根治性切除的GEJ肿瘤中，30%的区域淋巴结微转移通过细胞角蛋白特异性免疫组化检测到；没有明显的淋巴结受累。它们的存在意味着预后更差，DFS显著降低，这表明微转移的发现应该包括在分期系统中。(C)2004 Etsevier Ltd.Alt版权所有。
Aims. Aim of this study was to examine the presence and the prognostic impact of immunohistochemically identified nodal micrometastases in patients with astro-oesophageal junction (GEJ) carcinomas.Methods. Between January 1988 and December 2000, 148 patients underwent a radical (R0) resection with a two-field lymphadenectonny for a GEJ carcinoma. Specimens of 60 patients in whom conventional haematoxytin and eosin (H Et E) examination did not demonstrate lymph-node metastases (pN0) were available for immunohistochemical. (IHC) analysis using antibodies AE1/AE3 directed against cytokeratins. Paraffin embedded material of all. retrieved lymph nodes in these patients were seriatly sectioned and analysed by one pathologist after H Et E examination for the presence of micrometastases by IHC.Results. In 60 resection specimens initially staged as pN0 a total of 524 lymph nodes were available for IHC analyses. Micrometastases were detected in 126 out of 524 lymph nodes (24%), corresponding with 18 of the 60 patients (30%) who were upstaged by this technique. Compared with the pN0 group, the disease free survival (DFS) was significantly tower in patients with nodal involvement at IHC (p < 0.001). Survival of patients with IHC identified micrometastatic disease was comparable to those with H Et E positive lymph nodes.Conclusions. Micrometastases in regional nodes were detected by cytokeratinspecific IHC in 30% of radical resected GEJ tumours; without overt nodal involvement. Their presence conveys a worse prognosis with a significant reduced DFS, suggesting that the finding of micrometastases should be included in the staging system. (c) 2004 Etsevier Ltd. Alt rights reserved.