Fan Yue-zu, Li Xin-ping, Liu Wen-fang, Li Guang-ming
Department of Surgery, Tongji Hospital of Tongji University, Shanghai 200065, China.
Zhonghua Wai Ke Za Zhi. 2006 Feb 1;44(3):181-5.
To study lymph node micrometastases (LNMM), expression of nm23-H(1), MMP(9), TIMP(2) proteins, and their relationship and clinical significance in patients with stage Dukes B colorectal cancer.
Thirty patients with stage Dukes B colorectal cancer were studied. LNMM in these patients was detected by immunohistochemical anti-cytokeratin 20 (CK20) staining. The expression of nm23-H(1), MMP(9) and TIMP(2) proteins in primary tumors was examined by Strept-avidin-biotin complex method. Clinical-pathological data and survival of each patient were recorded and analyzed.
(1) The positive dyeing of CK20 was observed in 26.7% for cases and in 7.8% for lymph nodes of 30 patients with stage Dukes B colorectal cancer. (2) Different expression of nm23-H(1) and MMP(9) proteins in the patients between stage Dukes B and stage Dukes CD was observed (P < 0.05). The decreased nm23-H(1) expression, and/or the increased MMP(9) expression in primary stage Dukes B tumors were significantly associated with LNMM (P < 0.05). Sensitivity and specificity for detection of LNMM by using nm23-H(1) or MMP(9) were respectively 62.5% and 81.8% or 75.0% and 69.8%. If by combining nm23-H(1) with MMP(9), specificity for detection of LNMM became 90.9%. The expression of TIMP(2) protein was not related with stage Dukes and LNMM. (3) The percent of tumor recurrence and/or metastasis for the stage Dukes B patients with LNMM was significantly higher than that for the patients without LNMM (P < 0.05), but the survival percent for the patients with LNMM was significantly lower than that for the patients without LNMM. The outcome for the patients with nm23-H(1) (-) LNMM (+) or MMP(9) (+) LNMM (+) was significantly worse than that for patients with nm23-H(1) (+) LNMM (-) or MMP(9) (+) LNMM (-) (P < 0.05).
LNMM is detected by immunohistochemical anti-CK20 staining. The expression of nm23-H(1) and MMP(9) in primary stage Dukes B tumors was significantly associated with LNMM. The outcome in the LNMM patients with nm23-H(1) (-) and/or MMP(9) (+) were worse. Combining examination of CK20 for lymph nodes with expression of nm23-H(1) and MMP(9) for primary tumors is of important clinical significance for staging of Dukes, selection of adjuvant treatment and evaluation of prognosis in patients with colorectal cancer.
研究Dukes B期结直肠癌患者的淋巴结微转移（LNMM）、nm23-H(1)、MMP(9)、TIMP(2)蛋白的表达及其相互关系和临床意义。
对30例Dukes B期结直肠癌患者进行研究。采用免疫组织化学抗细胞角蛋白20（CK20）染色检测这些患者的LNMM。用链霉亲和素-生物素复合物法检测原发肿瘤中nm23-H(1)、MMP(9)和TIMP(2)蛋白的表达。记录并分析每位患者的临床病理资料和生存情况。
（1）30例Dukes B期结直肠癌患者中，病例的CK20阳性染色率为26.7%，淋巴结的阳性染色率为7.8%。（2）观察到Dukes B期和Dukes C/D期患者之间nm23-H(1)和MMP(9)蛋白的表达不同（P<0.05）。Dukes B期原发肿瘤中nm23-H(1)表达降低和/或MMP(9)表达增加与LNMM显著相关（P<0.05）。用nm23-H(1)或MMP(9)检测LNMM的敏感性和特异性分别为62.5%和81.8%或75.0%和69.8%。若将nm23-H(1)与MMP(9)联合检测，LNMM的检测特异性可达90.9%。TIMP(2)蛋白的表达与Dukes分期和LNMM无关。（3）有LNMM的Dukes B期患者的肿瘤复发和/或转移率显著高于无LNMM的患者（P<0.05），但有LNMM的患者的生存率显著低于无LNMM的患者。nm23-H(1)(-) LNMM(+)或MMP(9)(+) LNMM(+)患者的预后明显差于nm23-H(1)(+) LNMM(-)或MMP(9)(+) LNMM(-)患者（P<0.05）。
采用免疫组织化学抗CK20染色检测LNMM。Dukes B期原发肿瘤中nm23-H(1)和MMP(9)的表达与LNMM显著相关。nm23-H(1)(-)和/或MMP(9)(+)的LNMM患者预后较差。将淋巴结CK20检测与原发肿瘤nm23-H(1)和MMP(9)表达检测相结合，对结直肠癌患者的Dukes分期、辅助治疗选择及预后评估具有重要临床意义。
