Sato F, Shimada Y, Li Z, Watanabe G, Maeda M, Imamura M
Department of Surgery and Surgical Basic Science, Graduate School of Medicine, Kyoto University, Kawara-cho 54, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
Br J Surg. 2001 Mar;88(3):426-32. doi: 10.1046/j.1365-2168.2001.01687.x.
The purpose of this study was to investigate whether the presence of lymph node micrometastasis in pathological lymph node-negative (pN0) oesophageal squamous cell carcinoma had prognostic value.
Some 1840 lymph nodes were obtained from 50 patients with pN0 oesophageal squamous cell carcinoma who underwent curative resection of the primary tumour with systematic lymphadenectomy. These lymph nodes were examined immunohistochemically with anticytokeratin antibody (AE1/AE3). Lymph node micrometastases newly detected by immunohistochemistry were classified as micrometastasis. Additionally, lymph node micrometastases were classified into three stages: stage 1, one individual AE1/AE3-positive cell; stage 2, multiple individual positive cells; stage 3, one or multiple positive clusters.
Micrometastases were detected in 20 patients (40 per cent). A higher stage of micrometastasis was associated with greater pathological tumour (pT) size (P = 0.023). Recurrent tumours developed in nine patients. However, the frequency of recurrence was similar in patients with, or without, micrometastasis (five of 20 and four of 30 patients respectively; P = 0.25). Twenty-three of 30 patients without micrometastasis survived, whereas 15 of 20 patients with micrometastasis were still alive (5-year overall survival 75 and 78 percent respectively, P = 0.91). Twenty-six of 30 patients without micrometastasis had no recurrence, whereas 15 of 20 patients with micrometastasis had no recurrence (5-year relapse-free survival 86 and 73 per cent respectively, P = 0.37). There was no significant difference in prognosis with respect to the stages of micrometastasis. Multivariate analysis also showed that micrometastasis was not an independent prognostic factor (P = 0.73).
Immunohistochemical detection of lymph node micrometastasis may be an indicator of lymphatic dissemination of tumour cells. However, the presence of micrometastasis had no impact on the prognosis of node-negative patients with oesophageal squamous cell carcinoma.
本研究旨在探讨病理淋巴结阴性（pN0）的食管鳞状细胞癌中淋巴结微转移的存在是否具有预后价值。
从50例行原发性肿瘤根治性切除并系统性淋巴结清扫术的pN0食管鳞状细胞癌患者中获取约1840个淋巴结。用抗细胞角蛋白抗体（AE1/AE3）对这些淋巴结进行免疫组化检查。通过免疫组化新检测到的淋巴结微转移被归类为微转移。此外，淋巴结微转移分为三个阶段：1期，单个AE1/AE3阳性细胞；2期，多个单个阳性细胞；3期，一个或多个阳性细胞簇。
20例患者（40%）检测到微转移。微转移分期越高，病理肿瘤（pT）大小越大（P = 0.023）。9例患者出现复发肿瘤。然而，有微转移和无微转移患者的复发频率相似（分别为20例中的5例和30例中的4例；P = 0.25）。30例无微转移患者中有23例存活，而20例有微转移患者中有15例仍存活（5年总生存率分别为75%和78%，P = 0.91）。30例无微转移患者中有26例无复发，而20例有微转移患者中有15例无复发（5年无复发生存率分别为86%和73%，P = 0.37）。微转移分期对预后无显著差异。多因素分析也显示微转移不是独立的预后因素（P = 0.73）。
免疫组化检测淋巴结微转移可能是肿瘤细胞淋巴播散的一个指标。然而，微转移的存在对淋巴结阴性的食管鳞状细胞癌患者的预后没有影响。
