Lee Hye-Seung, Kim Min-A, Yang Han-Kwang, Lee Byung-Lan, Kim Woo-Ho
Department of Pathology, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-799, Korea.
World J Gastroenterol. 2005 Oct 14;11(38):5920-5. doi: 10.3748/wjg.v11.i38.5920.
To determine the prognostic significance of isolated tumor cells (ITCs) and lymph node micrometastases in gastric cancer.
Hematoxylin and eosin-stained slides of lymph node dissections of 632 consecutive gastric cancers were reviewed. Cytokeratin immunostaining was performed in 280 node-negative cases and 5 cases indefinite for lymph node metastases. Lymph node metastases were divided into ITCs, micrometastases, or macrometastases, according to the sizes of tumor deposits in largest dimension. ITCs were further classified into four groups according to metastasis pattern.
Lymph node metastases were identified by immunostaining in 58 of 280 node-negative cases (20.7%) and were not significantly associated with patient survival (P = 0.3460). After cytokeratin immunostaining, 196 cases were classified as pN1, which consisted of 20 cases with micrometastases detected by immunostaining (pN1mi(i+)), 34 cases with only micrometastases (pN1mi), and 142 cases with pN1 with one or more macrometastases (pN1). Cases with pN1mi and pN1mi(i+) had a significantly better prognosis than the cases with pN1 (P = 0.0037). ITCs were found in 38 of these 58 cases, and could be divided into four groups: 12 cases with only a single cell pattern, 7 cases with multiple individual cells, 5 cases with single small cluster, and 14 cases with multiple small clusters. Among these four groups, cases with ITCs of multiple individual cell pattern showed the worst survival (median survival: 28 mo, P<0.0001).
Both size and pattern of lymph node metastases can give prognostic information on the survival of gastric cancer patients.
确定孤立肿瘤细胞（ITCs）和淋巴结微转移在胃癌中的预后意义。
回顾了632例连续性胃癌淋巴结清扫的苏木精-伊红染色切片。对280例淋巴结阴性病例和5例淋巴结转移情况不明确的病例进行细胞角蛋白免疫染色。根据肿瘤沉积物最大径的大小，将淋巴结转移分为ITCs、微转移或大转移。ITCs根据转移模式进一步分为四组。
280例淋巴结阴性病例中有58例（20.7%）通过免疫染色发现淋巴结转移，且与患者生存率无显著相关性（P = 0.3460）。细胞角蛋白免疫染色后，196例被分类为pN1，其中包括20例通过免疫染色检测到微转移的病例（pN1mi(i+)）、34例仅存在微转移的病例（pN1mi）和142例有一个或多个大转移的pN1病例（pN1）。pN1mi和pN1mi(i+)病例的预后明显优于pN1病例（P = 0.0037）。这58例病例中有38例发现了ITCs，可分为四组：12例仅为单个细胞模式、7例为多个单个细胞、5例为单个小细胞簇、14例为多个小细胞簇。在这四组中，具有多个单个细胞模式ITCs的病例生存率最差（中位生存期：28个月，P<0.0001）。
淋巴结转移的大小和模式均可为胃癌患者的生存提供预后信息。
