Bonavina L, Ferrero S, Midolo V, Buffa R, Cesana B, Peracchia A
Department of General Surgery, University of Milan School of Medicine, Ospedale Maggiore Policlinico, IRCCS, Milano, Italy.
J Gastrointest Surg. 1999 Sep-Oct;3(5):468-76. doi: 10.1016/s1091-255x(99)80099-7.
Recurrences of adenocarcinoma of the esophagogastric junction are frequent even in patients who are classified as pN0 after radical resection, suggesting that occult nodal metastases may have been missed on routine histologic examination. Immunohistochemical analysis using antibodies to cytokeratin was retrospectively performed in 1301 lymph nodes from 46 patients who underwent surgical resection for adenocarcinoma of the esophagogastric junction through a laparotomy and a right thoracotomy. Compared to routinely stained sections, the total number of metastatic lymph nodes was significantly (P = 0.0001) increased when both serial sectioning and anticytokeratin immunohistochemical analysis were performed. Overall 6 (33.3%) of the 18 patients previously considered N0 were recategorized as N1 for the presence of micrometastases to lesser curvature nodes. Three of these patients had recurrent disease within the first year of follow-up. Both the probability of survival or no recurrence and the disease-free survival were significantly greater in patients in whom the ratio of invaded to removed lymph nodes was less than 0.2. Anticytokeratin analysis identified occult nodal metastases in one third of our patients with adenocarcinoma of the esophagogastric junction. This modified tumor staging and had an impact on overall and disease-free survival.
即使在根治性切除术后被分类为pN0的患者中，食管胃交界腺癌的复发也很常见，这表明在常规组织学检查中可能遗漏了隐匿性淋巴结转移。对46例通过剖腹术和右胸切开术进行食管胃交界腺癌手术切除的患者的1301个淋巴结进行了回顾性免疫组织化学分析，使用细胞角蛋白抗体。与常规染色切片相比，当进行连续切片和抗细胞角蛋白免疫组织化学分析时，转移淋巴结的总数显著增加（P = 0.0001）。总体而言，18例先前被认为是N0的患者中有6例（33.3%）因小弯淋巴结微转移而重新分类为N1。其中3例患者在随访的第一年内出现疾病复发。侵袭淋巴结与切除淋巴结的比例小于0.2的患者，生存或无复发的概率以及无病生存率均显著更高。抗细胞角蛋白分析在三分之一的食管胃交界腺癌患者中发现了隐匿性淋巴结转移。这改变了肿瘤分期，并对总生存期和无病生存期产生了影响。
