Tsujitani S, Kaibara N
Department of Surgery I, Faculty of Medicine, Tottori University, Yonago, Japan.
Nihon Geka Gakkai Zasshi. 2001 Oct;102(10):741-4.
Micrometastases are considered to be a cause of recurrence after curative surgery for gastric cancer. It is important to clarify the clinicopathologic characteristics of micrometastases in the lymph nodes and peritoneal cavity to determine the treatment options in gastric cancer. Two consecutive sections of lymph nodes from patients with various cancers were examined by simultaneous staining with ordinary hematoxylin and eosin (H & E) and immunostaining with anti-cytokeratin antibody, respectively. Micrometastases in the lymph nodes were found in 18% of mucosal cancer, 25% of submucosal cancer, and 65% of T3 (serosal) cancers pecimens, with cancer-free nodes examined by H & E staining. A reduced 5-year survival rate was demonstrated in patients with nodal micrometastases among those with submucosal cancer and those with T3 cancer and cancer-free nodes examined by H & E staining. Molecular biological detection (MBD) of micrometastasis in lavage cytology specimens was performed by RT-PCR of carcinoembryonic antigen mRNA or telomerase activity assay. MBD protocols revealed micrometastases in cases with negative cytology results. Survival analysis demonstrated peritoneal recurrences in MBD-positive cases, whereas there was no recurrence in MBD-negative cases. Peritoneal micrometastases detected by MBD protocols appear to be a significant risk factor for recurrence. Therefore indications for lymph node dissection and postoperative chemotherapy should be determined based on the findings of micrometastases in gastric cancer.
微转移被认为是胃癌根治性手术后复发的一个原因。明确淋巴结和腹腔微转移的临床病理特征对于确定胃癌的治疗方案很重要。分别用普通苏木精和伊红（H&E）染色以及抗细胞角蛋白抗体免疫染色对患有各种癌症的患者的连续两个淋巴结切片进行检查。在经H&E染色检查无癌转移的淋巴结中，微转移在18%的黏膜癌、25%的黏膜下癌和65%的T3（浆膜）癌标本中被发现。在黏膜下癌和T3癌且经H&E染色检查无癌转移的患者中，有淋巴结微转移的患者5年生存率降低。通过癌胚抗原mRNA的逆转录聚合酶链反应（RT-PCR）或端粒酶活性测定对灌洗细胞学标本中的微转移进行分子生物学检测（MBD）。MBD方案在细胞学结果为阴性的病例中发现了微转移。生存分析显示MBD阳性病例有腹膜复发，而MBD阴性病例无复发。通过MBD方案检测到的腹膜微转移似乎是复发的一个重要危险因素。因此，应根据胃癌微转移的检查结果来确定淋巴结清扫和术后化疗的指征。
