Passlick B, Thetter O, Pantel K, Kubuschok B, Pichlmeier U, Schweiberer L, Izbicki J R
Chirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität München.
Chirurg. 1995 Aug;66(8):780-5; discussion 785-6.
Encountering the high incidence of tumor recurrences in patients with apparently resectable non-small cell lung cancer it has to be assumed that in many patients already at the time of surgery a tumor cell dissemination has occurred, which is underestimated by current staging procedures. We therefore conducted a prospective study to assess the frequency and prognostic significance of a nodal tumor cell dissemination by using an immunohistochemical assay. Disseminated epithelial cells were demonstrated in 35 (6.2%) out of 565 lymph nodes staged as tumor free by conventional histopathology and in 27 (21.6%) out of 125 patients, respectively. In pN0 patients disseminated tumor cells were detected in 11/70 (15.7%) cases. In patients staged as pN1 and pN2 by conventional histopathology a tumor cell dissemination to additional lymph nodes was demonstrated by immunohistochemistry in 4/25 (16.0%) and in 12/30 (40.0%) patients, respectively (p = 0.019). Independent from tumor staging univariate survival analysis showed that the detection of a nodal tumor cell dissemination was associated with a reduced disease-free survival (p < 0.001). Multivariate analysis demonstrated that the detection of such cells is an independent prognostic parameter (p = 0.005). In conclusion, the use of immunohistochemistry enables to identify many patients with a widespread regional tumor cell dissemination at the time of surgery. This finding could represent a new criterion for an adjuvant therapeutic regime.
鉴于在明显可切除的非小细胞肺癌患者中肿瘤复发率较高，不得不假定在许多患者中，甚至在手术时就已经发生了肿瘤细胞播散，而目前的分期程序对此估计不足。因此，我们进行了一项前瞻性研究，通过免疫组织化学检测来评估淋巴结肿瘤细胞播散的频率及其预后意义。在565个经传统组织病理学检查判定为无肿瘤的淋巴结中，有35个（6.2%）检测到了播散的上皮细胞，在125例患者中有27例（21.6%）检测到。在pN0患者中，11/70（15.7%）的病例检测到了播散的肿瘤细胞。在经传统组织病理学判定为pN1和pN2的患者中，免疫组织化学分别在4/25（16.0%）和12/30（40.0%）的患者中检测到肿瘤细胞播散至其他淋巴结（p = 0.019）。单因素生存分析显示，与肿瘤分期无关，检测到淋巴结肿瘤细胞播散与无病生存期缩短相关（p < 0.001）。多因素分析表明，检测到此类细胞是一个独立的预后参数（p = 0.005）。总之，免疫组织化学的应用能够识别出许多在手术时存在广泛区域肿瘤细胞播散的患者。这一发现可能代表辅助治疗方案的一个新标准。
