Wang Hong-wei, Yao Yun-feng, Li Ming, Gu Jin
Department of Gastrointestinal Surgery II, Peking University, Beijing 100142, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2010 Mar;13(3):189-92.
To investigate the occult lymph node metastasis in the middle and lower third rectal cancer after neoadjuvant radiotherapy.
From June 2003 to December 2006, 74 rectal cancer patients received neoadjuvant radiotherapy (30 Gy/10 f/2 w, CACA-CRC-001) and underwent total mesorectal excision (TME) two weeks later. Fat clearance technique was used in all the samples. Occult lymph node metastasis was detected in the mesorectum using the anti-CK antibody.
In total 1883 retrieved lymph nodes, 172 metastasis lymph nodes were harvested by HE examination with the mean diameter [(4.9+/-2.6) mm] being larger than that (2.7+/-1.4) mm of the 1711 negative nodes (P<0.01). In HE negative nodes, occult metastasis was found in 40 lymph nodes (2.33%) from 24 patients. Most of these nodes were less than 5 mm (90.0%) with a mean diameter of (3.2+/-1.2)mm, smaller than those of HE-positive metastasis nodes (P<0.01). Occult metastasis was found in 23.1% (9/39) of HE-negative patients. Occult metastasis incidence was higher in patients with HE-positive nodes (42.8%,P<0.01). No correlation of lymph node occult metastasis with tumor differentiation, age, or surgical procedures was found. There was no significant difference in recurrence-free survival between ypN(0) patients with and without occult metastasis (P=0.157).
It is not necessary to include occult lymph node metastasis in the TNM staging in patients with ypN(0) rectal cancer.
探讨新辅助放疗后中下段直肠癌的隐匿性淋巴结转移情况。
2003年6月至2006年12月，74例直肠癌患者接受新辅助放疗（30 Gy/10次/2周，CACA-CRC-001），两周后行全直肠系膜切除术（TME）。所有样本均采用脂肪清除技术。使用抗细胞角蛋白（CK）抗体检测直肠系膜中的隐匿性淋巴结转移。
共检索到1883枚淋巴结，其中172枚经苏木精-伊红（HE）染色检查为转移淋巴结，其平均直径为（4.9±2.6）mm，大于1711枚阴性淋巴结的平均直径（2.7±1.4）mm（P<0.01）。在HE染色阴性的淋巴结中，24例患者的40枚淋巴结（2.33%）发现隐匿性转移。这些淋巴结大多小于5 mm（90.0%），平均直径为（3.2±1.2）mm，小于HE染色阳性的转移淋巴结（P<0.01）。HE染色阴性患者中23.1%（9/39）发现隐匿性转移。HE染色阳性患者的隐匿性转移发生率更高（42.8%，P<0.01）。未发现淋巴结隐匿性转移与肿瘤分化、年龄或手术方式相关。ypN(0)且无隐匿性转移的患者与有隐匿性转移的患者在无复发生存率方面无显著差异（P=0.157）。
对于ypN(0)的直肠癌患者，无需将隐匿性淋巴结转移纳入TNM分期。
