Komukai S, Nishimaki T, Watanabe H, Ajioka Y, Suzuki T, Hatakeyama K
First Department of Pathology, Niigata University School of Medicine, Japan.
Surgery. 2000 Jan;127(1):40-6. doi: 10.1067/msy.2000.102754.
We examined the prevalence, patterns, and clinical significance of nodal micrometastases in patients with esophageal cancer.
Cervical, mediastinal, and abdominal lymph nodes systematically removed from 37 patients without conventional histologic evidence of lymph node metastasis from esophageal squamous cell carcinoma were immunohistochemically examined to detect cells that were stained for cytokeratins by the monoclonal antibody cocktail AE1/AE3. Postoperative care and survival were compared in cases with and without such micrometastases.
Nodal micrometastases were found in 14 of 37 patients (38%). Among these patients, 9, 7, and 4 had micrometastases to abdominal, mediastinal, and cervical lymph nodes, respectively. Postoperative tumor recurrence was significantly more frequent in patients with micrometastases (50%) than in those without (9%, P = .008). Overall and relapse-free survival in the former group was significantly worse than in the latter group (P = .042 and P = .002, respectively). Nodal micrometastases had an independent prognostic importance for relapse-free survival as determined by multivariate analysis.
Metastatic tumor cells are frequently present in lymph nodes, even in patients without histologic evidence of nodal metastasis from esophageal cancer. Nodal micrometastases indicates a poorer prognosis after a curative esophagectomy procedure in histologically node-negative cases.
我们研究了食管癌患者淋巴结微转移的发生率、模式及临床意义。
对37例无食管鳞状细胞癌淋巴结转移常规组织学证据的患者,系统性切除其颈部、纵隔及腹部淋巴结,采用免疫组织化学方法检测经单克隆抗体鸡尾酒AE1/AE3染色的细胞角蛋白阳性细胞。比较有无此类微转移患者的术后护理及生存情况。
37例患者中有14例(38%)发现淋巴结微转移。其中,分别有9例、7例和4例患者的腹部、纵隔及颈部淋巴结出现微转移。微转移患者的术后肿瘤复发率(50%)显著高于无微转移患者(9%,P = 0.008)。前一组患者的总生存期和无复发生存期显著短于后一组(分别为P = 0.042和P = 0.002)。多因素分析显示,淋巴结微转移对无复发生存期具有独立的预后意义。
即使在无食管癌淋巴结转移组织学证据的患者中,转移瘤细胞也常存在于淋巴结中。在组织学检查淋巴结阴性的病例中,淋巴结微转移表明根治性食管切除术后预后较差。