[细胞角蛋白和Ca 19-9抗原在胰腺癌淋巴结中播散肿瘤细胞免疫组织学检测中的价值]

[Value of cytokeratin and Ca 19-9 antigen in immunohistological detection of disseminated tumor cells in lymph nodes in pancreas carcinoma].

作者信息

Ridwelski K, Meyer F, Fahlke J, Kasper U, Roessner A, Lippert H

机构信息

Klinik und Poliklinik für Chirurgie, Universitätsklinikum Magdeburg, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg.

出版信息

Chirurg. 2001 Aug;72(8):920-6. doi: 10.1007/s001040170089.

DOI:10.1007/s001040170089

PMID:11554137

Abstract

INTRODUCTION

Based on the fact that pancreatic carcinoma is still associated with poor outcome, the aim of the study was to determine frequency of early tumor cell dissemination using immunohistology in lymph nodes classified as tumor-free by conventional histopathology.

METHODS

Fifteen patients with ductal pancreatic carcinoma and 10 patients with carcinoma of the papilla of Vater underwent radical tumor resection (resection status R0, tumor staging pTxpN0M0). In total, 229 lymph nodes classified as tumor-free by histopathology were investigated for disseminated tumor cells using antibodies against cytokeratin and CA19-9. As control, 81 lymph nodes obtained from patients with chronic pancreatitis were analyzed.

RESULTS

In 55 of 229 lymph nodes (26.3%), cytokeratin-positive, disseminated tumor cells were detected. Cytokeratin-positive cells were found in at least one resected lymph node of each patient with ductal carcinoma of the pancreatic head (100%), whereas in patients with carcinoma of the papilla of Vater, no disseminated tumor cells were detected using the antibody against cytokeratin. Similarly, there was no detection of tumor cells (false-positive) in patients with chronic pancreatitis. In contrast, CA19-9 antigen was detectable in resected lymph nodes of each of the 25 carcinoma patients (pancreatic carcinoma and carcinoma of the papilla of Vater). Interestingly, 52 of 81 lymph nodes (64.2%) from the control group (chronic pancreatitis) were false-positive.

CONCLUSION

Detection of disseminated tumor cells in lymph nodes using an antibody against cytokeratin is specific and suitable while use of an antibody against CA19-9 is not recommendable because of the high rate of false-positive results. The results may indicate that ductal pancreatic carcinoma generates early dissemination of tumor cells into lymph nodes. This may be one explanation for the poor outcome of this carcinoma compared with that of the carcinoma of the papilla of Vater (14 versus 48 months P < 0.05).

摘要

引言

鉴于胰腺癌的预后仍然较差，本研究的目的是利用免疫组织化学方法确定在常规组织病理学分类为无肿瘤的淋巴结中早期肿瘤细胞播散的频率。

方法

15例胰腺导管癌患者和10例 Vater 乳头癌患者接受了根治性肿瘤切除术（切除状态R0，肿瘤分期pTxpN0M0）。总共对229个经组织病理学分类为无肿瘤的淋巴结进行研究，使用抗细胞角蛋白和CA19-9抗体检测播散的肿瘤细胞。作为对照，分析了从慢性胰腺炎患者获得的81个淋巴结。

结果

在229个淋巴结中的55个（26.3%）检测到细胞角蛋白阳性的播散肿瘤细胞。在每例胰头导管癌患者的至少一个切除淋巴结中均发现细胞角蛋白阳性细胞（100%），而在 Vater 乳头癌患者中，使用抗细胞角蛋白抗体未检测到播散肿瘤细胞。同样，慢性胰腺炎患者未检测到肿瘤细胞（假阳性）。相比之下，在25例癌症患者（胰腺癌和 Vater 乳头癌）的每例切除淋巴结中均检测到CA19-9抗原。有趣的是，对照组（慢性胰腺炎）的81个淋巴结中有52个（64.2%）为假阳性。