Heeren P A M, Kelder W, Blondeel I, van Westreenen H L, Hollema H, Plukker J Th
Department of Surgery, University Hospital Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
Eur J Surg Oncol. 2005 Apr;31(3):270-6. doi: 10.1016/j.ejso.2004.12.001.
Aim of this study was to examine the presence and the prognostic impact of immunohistochemically identified nodal micrometastases in patients with gastro-oesophageal junction (GEJ) carcinomas.
Between January 1988 and December 2000, 148 patients underwent a radical (R0) resection with a two-field lymphadenectomy for a GEJ carcinoma. Specimens of 60 patients in whom conventional haematoxylin and eosin (H & E) examination did not demonstrate lymph-node metastases (pN0) were available for immunohistochemical (IHC) analysis using antibodies AE1/AE3 directed against cytokeratins. Paraffin embedded material of all retrieved lymph nodes in these patients were serially sectioned and analysed by one pathologist after H & E examination for the presence of micrometastases by IHC.
In 60 resection specimens initially staged as pN0 a total of 524 lymph nodes were available for IHC analyses. Micrometastases were detected in 126 out of 524 lymph nodes (24%), corresponding with 18 of the 60 patients (30%) who were upstaged by this technique. Compared with the pN0 group, the disease free survival (DFS) was significantly lower in patients with nodal involvement at IHC (p<0.001). Survival of patients with IHC identified micrometastatic disease was comparable to those with H & E positive lymph nodes.
Micrometastases in regional nodes were detected by cytokeratin-specific IHC in 30% of radical resected GEJ tumours without overt nodal involvement. Their presence conveys a worse prognosis with a significant reduced DFS, suggesting that the finding of micrometastases should be included in the staging system.
本研究旨在检测胃食管交界（GEJ）癌患者中免疫组化鉴定的淋巴结微转移的存在情况及其预后影响。
1988年1月至2000年12月期间，148例患者因GEJ癌接受了根治性（R0）切除及二野淋巴结清扫术。60例常规苏木精和伊红（H&E）检查未显示淋巴结转移（pN0）的患者标本可用于使用针对细胞角蛋白的抗体AE1/AE3进行免疫组化（IHC）分析。这些患者所有回收淋巴结的石蜡包埋材料经连续切片，由一名病理学家在H&E检查后通过IHC分析微转移的存在情况。
在最初分期为pN0的60例切除标本中，共有524个淋巴结可用于IHC分析。524个淋巴结中有126个（24%）检测到微转移，这与60例患者中的18例（30%）通过该技术分期上调相对应。与pN0组相比，IHC检测到淋巴结受累的患者无病生存期（DFS）显著更低（p<0.001）。IHC鉴定为微转移疾病的患者生存率与H&E阳性淋巴结患者相当。
在30%根治性切除的无明显淋巴结受累的GEJ肿瘤中，通过细胞角蛋白特异性IHC检测到区域淋巴结微转移。它们的存在预示着预后更差，DFS显著降低，这表明微转移的发现应纳入分期系统。
