淋巴绘图对结直肠癌新的肿瘤-淋巴结-转移分类的影响。

Effect of lymphatic mapping on the new tumor-node-metastasis classification for colorectal cancer.

作者信息

Bilchik Anton J, Nora Dean T, Sobin Leslie H, Turner Roderick R, Trocha Steven, Krasne David, Morton Donald L

机构信息

Division of Surgical Oncology, John Wayne Cancer Institute at Saint John's Health Center, 2200 Santa Monica Boulevard, Santa Monica, CA 90404, USA.

出版信息

J Clin Oncol. 2003 Feb 15;21(4):668-72. doi: 10.1200/JCO.2003.04.037.

DOI:10.1200/JCO.2003.04.037

PMID:12586804

Abstract

PURPOSE

Sensitive detection methods and accurate reporting are necessary to determine the prognostic significance of micrometastases (MM) and isolated tumor cells (ITCs) in lymph nodes that drain colorectal cancers (CRCs). This study examined the role of lymphatic mapping (LM) in the application of the new tumor-node-metastasis (TNM) classification for MM and ITC.

PATIENTS AND METHODS

All patients at the John Wayne Cancer Institute underwent LM immediately before standard resection of primary CRC between 1996 and 2001. Sentinel nodes (SNs) were identified using blue dye and/or radiotracer and were examined by hematoxylin-eosin (H&E) staining, cytokeratin immunohistochemistry, and multilevel sectioning. The comparison group comprised 370 patients whose primary CRCs were resected without LM during the same period at the same institution.

RESULTS

LM was successfully performed in 115 of 120 (96%) patients and correctly predicted the tumor status of the nodal basin in 110 of 115 (96%) patients. Thirty-seven patients (32%) were lymph node-positive by H&E, ITC and MM were found in 23 patients (29.4%) whose lymph nodes were negative by H&E. Tumor deposits were found in the SN only in 29 patients (50%). Nodal involvement was identified for 14.3%, 30%, 74.6%, and 83.3% of T1, T2, T3, and T4 tumors, respectively, in the study group, and for 6.8%, 8.5%, 49.3%, and 41.8% of T1, T2, T3, and T4 tumors, respectively, in the comparison group. The study group had a higher percentage of nodal metastases (53% v 36%; P <.01) and a higher incidence of MM and ITC (29.4% v 1.9%; P <.0001). The mean number of lymph nodes found in the study group (14) was also significantly more than the number found in the comparison group (10; P <.00001).

CONCLUSION

Conventional examination of lymph nodes for CRC is inadequate for the detection of MM and ITC as described in the new TNM classification. Thus, LM and focused SN analysis should be considered to fully stage CRC.

摘要

目的

灵敏的检测方法和准确的报告对于确定结直肠癌（CRC）引流区域淋巴结中微转移（MM）和孤立肿瘤细胞（ITC）的预后意义至关重要。本研究探讨了淋巴绘图（LM）在MM和ITC新的肿瘤-淋巴结-转移（TNM）分类应用中的作用。

患者与方法

1996年至2001年间，约翰·韦恩癌症研究所的所有患者在原发性CRC标准切除术前立即接受了LM。使用蓝色染料和/或放射性示踪剂识别前哨淋巴结（SN），并通过苏木精-伊红（H&E）染色、细胞角蛋白免疫组织化学和多层切片进行检查。对照组包括同期在同一机构接受原发性CRC切除但未进行LM的370例患者。

结果

120例患者中有115例（96%）成功进行了LM，其中115例中的110例（96%）正确预测了淋巴结区域的肿瘤状态。37例患者（32%）H&E检查淋巴结阳性，23例（29.4%）H&E检查淋巴结阴性的患者中发现了ITC和MM。仅在29例患者（50%）的SN中发现肿瘤沉积物。研究组中T1、T2、T3和T4肿瘤的淋巴结受累率分别为14.3%、30%、74.6%和83.3%，对照组中分别为6.8%、8.5%、49.3%和41.8%。研究组的淋巴结转移百分比更高（53%对36%；P<.01），MM和ITC的发生率也更高（29.4%对1.9%；P<.0001）。研究组发现的淋巴结平均数量（14个）也明显多于对照组（10个；P<.00001）。