Koike Hiroshi, Ichikawa Daisuke, Kitamura Kazuya, Tsuchihashi Yasunari, Yamagishi Hisakazu
Department of Digestive Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Surgery. 2004 Mar;135(3):266-72. doi: 10.1016/j.surg.2003.08.017.
En-bloc resection for cancer has been a standard procedure based on the concept that there may be a small number of "invisible" cancer cells around the primary tumor and metastatic lymph nodes. However, there are few histopathologic studies of this issue.
Perinodal involvement of cancer cells, defined as existence of cancer cells in the attached fatty tissue around the dissected lymph nodes, was assessed in 123 node-positive and 15 node-negative gastric cancers by both hematoxylin-eosin staining and immunohistochemistry.
Perinodal involvement was found in 79 (57%) of the 138 patients. The incidence was higher in patients with tumors invading the deeper layer, the macroscopic diffuse type, the presence of lymphatic or vascular invasion (P<.05), and advanced disease (stage I, 17%; II, 62%; III, 67%; IV, 80%). Survival of patients with perinodal involvement was less than that of patients without perinodal involvement (46% vs 87%; P<.005). Perinodal involvement was found, by multivariate analyses, to be a significant prognostic factor.
Perinodal cancer cells are observed frequently in gastric cancers with lymph node metastases, and the involvement appears to be a reliable prognostic factor for gastric cancers.
基于原发肿瘤和转移淋巴结周围可能存在少量“隐匿性”癌细胞的概念，整块切除癌症一直是一种标准手术。然而，关于这个问题的组织病理学研究很少。
通过苏木精-伊红染色和免疫组织化学对123例淋巴结阳性和15例淋巴结阴性的胃癌患者进行评估，确定癌细胞的淋巴结周围浸润情况，即切除淋巴结周围附着脂肪组织中癌细胞的存在情况。
138例患者中有79例（57%）发现有淋巴结周围浸润。在肿瘤侵犯更深层、大体弥漫型、存在淋巴或血管浸润（P<0.05）以及晚期疾病（I期，17%；II期，62%；III期，67%；IV期，80%）的患者中，发生率更高。有淋巴结周围浸润的患者生存率低于无淋巴结周围浸润的患者（46%对87%；P<0.005）。多因素分析发现，淋巴结周围浸润是一个显著的预后因素。
在有淋巴结转移的胃癌中经常观察到淋巴结周围癌细胞，并且这种浸润似乎是胃癌的一个可靠预后因素。
