结直肠癌患者的淋巴结微转移模式与预后

Pattern of lymph node micrometastasis and prognosis of patients with colorectal cancer.

作者信息

Yasuda K, Adachi Y, Shiraishi N, Yamaguchi K, Hirabayashi Y, Kitano S

机构信息

Department of Surgery I, Oita Medical University, Japan.

出版信息

Ann Surg Oncol. 2001 May;8(4):300-4. doi: 10.1007/s10434-001-0300-5.

DOI:10.1007/s10434-001-0300-5

PMID:11352302

Abstract

BACKGROUND

Studies of lymph node micrometastases in patients with colorectal cancer have ignored the prognostic significance of the number and level of lymph node micrometastases. The aim of this study was to clarify the prognostic significance of the status of lymph node micrometastases in histologically node-negative colorectal cancer.

METHODS

We used immunohistochemistry with anti-cytokeratin antibody CAM5.2 to examine 1013 lymph nodes in 42 patients (12 recurrent and 30 nonrecurrent) with histologically determined Dukes' B colorectal cancer. Five serial 6-microm sections were used for immunohistochemical staining. The frequency, tumor cell pattern, and number and level of lymph node micrometastases were compared between the recurrent and nonrecurrent groups.

RESULTS

Micrometastasis was confirmed in 16% (59/373) of lymph nodes in the recurrent group and 12% (77/640) of lymph nodes in the nonrecurrent group, and the frequency of lymph node micrometastases was 92% (11/12) in the recurrent group and 70% (21/30) in the nonrecurrent group. The tumor cell pattern in the metastatic lymph nodes was similar in the recurrent and nonrecurrent groups. Micrometastasis in four or more lymph nodes occurred more frequently in the recurrent group than in the nonrecurrent group (58% vs. 20%, P < .05), and micrometastasis to N2 or higher nodes occurred more frequently in the recurrent group than in the nonrecurrent group (92% vs. 47%, P < .01).

CONCLUSIONS

The number and level of positive micrometastatic lymph nodes was significantly correlated with postoperative recurrence of histologically determined Dukes' B colorectal cancer. This parameter is a useful prognostic indicator in histologically node-negative colorectal cancer and is helpful in planning adjuvant chemotherapy.

摘要

背景

结直肠癌患者淋巴结微转移的研究忽略了淋巴结微转移数量及水平的预后意义。本研究旨在阐明组织学检查淋巴结阴性的结直肠癌中淋巴结微转移状态的预后意义。

方法

我们采用抗细胞角蛋白抗体CAM5.2进行免疫组化，检查42例组织学确诊为Dukes B期结直肠癌患者（12例复发患者和30例未复发患者）的1013个淋巴结。使用五张连续的6微米切片进行免疫组化染色。比较复发组和未复发组之间淋巴结微转移的频率、肿瘤细胞模式以及数量和水平。

结果

复发组中16%（59/373）的淋巴结证实有微转移，未复发组中12%（77/640）的淋巴结有微转移，复发组淋巴结微转移频率为92%（11/12），未复发组为70%（21/30）。复发组和未复发组转移淋巴结中的肿瘤细胞模式相似。复发组中四个或更多淋巴结出现微转移的频率高于未复发组（58%对20%，P <.05），复发组中转移至N2或更高水平淋巴结的频率高于未复发组（92%对47%，P <.01）。