Department of General Surgery, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.
HPB (Oxford). 2007;9(2):135-9. doi: 10.1080/13651820601090646.
Occurrence of tumor relapse is frequent in patients with carcinoma of the papilla of Vater despite the absence of residual tumor detectable at primary surgery. Therefore it has to be assumed that current tumor staging procedures fail to identify minimal amounts of tumor cells disseminated to secondary organs, which might be precursors of subsequent metastatic relapse. The aim of the study was to assess the frequency and prognostic impact of minimal tumor cell spread in lymph nodes classified as 'tumor-free' in routine histopathologic evaluation.
A total of 41 'tumor-free' lymph nodes from 23 patients with adenocarcinoma of the papilla of Vater who underwent curative tumor resection (R0) were examined by immunohistochemistry with the monoclonal anti-EpCAM antibody Ber-EP4 for minimal disseminated tumor cells.
Twelve (29.3%) of the 41 'tumor-free' lymph nodes obtained from 9 (39.1%) of the 23 patients displayed EpCAM-positive cells. Kaplan-Meier survival analysis revealed that patients with EpCAM-positive cells in lymph showed a clearly reduced relapse-free and overall survival compared with patients without such cells. However, these differences were not statistically significant (p = 0.13 for relapse-free survival, p = 0.11 for overall survival).
Immunohistochemical assessment may refine the staging of resected lymph nodes in patients with carcinoma of the papilla of Vater. However, the presence of minimal disseminated tumor cells in lymph nodes had no significant impact on the prognosis in these patients.
尽管在初次手术时未检测到残留肿瘤，但 Vater 乳头癌患者仍经常发生肿瘤复发。因此，我们不得不假设目前的肿瘤分期程序无法识别少量播散到次级器官的肿瘤细胞，这些细胞可能是随后发生转移性复发的前兆。本研究旨在评估在常规组织病理学评估中被归类为“无肿瘤”的淋巴结中微小肿瘤细胞扩散的频率及其对预后的影响。
对 23 例接受根治性肿瘤切除（R0）的 Vater 乳头腺癌患者的 41 个“无肿瘤”淋巴结进行了免疫组织化学检查，使用单克隆抗-EpCAM 抗体 Ber-EP4 检测微小播散的肿瘤细胞。
在 23 例患者中的 9 例（39.1%）的 41 个“无肿瘤”淋巴结中，有 12 个（29.3%）显示 EpCAM 阳性细胞。Kaplan-Meier 生存分析显示，淋巴结中存在 EpCAM 阳性细胞的患者与无此类细胞的患者相比，无复发生存期和总生存期明显缩短。然而，这些差异无统计学意义（无复发生存期的 p = 0.13，总生存期的 p = 0.11）。
免疫组织化学评估可能会改善 Vater 乳头癌患者切除淋巴结的分期。然而，淋巴结中存在微小播散的肿瘤细胞对这些患者的预后没有显著影响。
