Scheunemann Peter, Stoecklein Nikolas H, Hermann Kai, Rehders Alexander, Eisenberger Claus F, Knoefel Wolfram T, Hosch Stefan B
Department of General Surgery, University Hospital Düsseldorf, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany.
Langenbecks Arch Surg. 2009 Jan;394(1):105-13. doi: 10.1007/s00423-008-0369-4. Epub 2008 Jul 15.
In gastric cancer, regional lymph node metastasis verified by histopathological examination is the most important prognostic factor after complete surgical tumor resection (R0). However, the prognostic value of immunohistochemically identifiable disseminated tumor cells in lymph nodes without histopathological tumor burden in patients with gastric cancer is still controversially discussed. The aim of the study was to assess the frequency and prognostic impact of minimal tumor cell spread to lymph nodes in these patients.
PATIENTS-METHODS: One hundred sixty lymph nodes judged as "tumor free" on routine histopathology obtained from 58 patients with gastric adenocarcinoma were analyzed immunohistochemically using the monoclonal anti-EpCAM antibody Ber-EP4 for occult disseminated tumor cells.
Tumor cells in lymph nodes were detected in 62 (38.8%) of the 160 "tumor-free" lymph nodes obtained from 39 (67.2%) patients. Multivariate Cox regression analysis confirmed the presence of disseminated tumor cells in "tumor-free" lymph nodes as an independent prognostic factor for both a significantly reduced relapse-free survival (p = 0.008) and overall survival (p = 0.009).
The frequent occurrence and prognostic impact of minimal disseminated tumor cells in lymph nodes of patients with gastric carcinoma support the need for a refined staging system of excised lymph nodes, which should include immunohistochemical examination.
在胃癌中，经组织病理学检查证实的区域淋巴结转移是肿瘤完整手术切除（R0）后最重要的预后因素。然而，对于胃癌患者中淋巴结内免疫组化可识别的播散性肿瘤细胞在无组织病理学肿瘤负荷时的预后价值仍存在争议。本研究的目的是评估这些患者中肿瘤细胞微转移至淋巴结的频率及其对预后的影响。
对58例胃腺癌患者常规组织病理学检查判定为“无肿瘤”的160枚淋巴结，使用抗EpCAM单克隆抗体Ber-EP4进行免疫组化分析，以检测隐匿的播散性肿瘤细胞。
在从39例（67.2%）患者获取的160枚“无肿瘤”淋巴结中，62枚（38.8%）检测到肿瘤细胞。多因素Cox回归分析证实，“无肿瘤”淋巴结中存在播散性肿瘤细胞是无复发生存期（p = 0.008）和总生存期（p = 0.009）显著降低的独立预后因素。
胃癌患者淋巴结中微小播散性肿瘤细胞的频繁出现及其对预后的影响，支持需要建立一个完善的切除淋巴结分期系统，其中应包括免疫组化检查。
