The Clinical and Pathological Significance of Detection of Lymph Node Micrometastasis by Flow Cytometry in Esophageal Squamous Carcinoma
-
摘要: 目的:选定食管鳞癌特异性标记物CK-19用流式细胞术检测食管鳞癌区域淋巴结是否存在微转移,分析其与预后的关系,探寻"逆向预后"的原因,指导临床治疗。方法:CK-19基因表达于食管上皮组织,但在正常淋巴结不表达。1998年1月至1999年12月随机抽取根治性切除食管鳞癌100例,共清扫出淋巴结1248枚。用流式细胞术检测光镜下阴性的淋巴结分析影响淋巴结微转移的相关因素。结果:279枚常规病理学检测转移的淋巴结经流式检测证实,67例及969枚光镜阴性淋巴结,流式细胞术检测其中28例及156枚淋巴结有微小转移,其微小转移率为41.8%,微小转移度为16.1%,其1、3、5年生存率分别为82.1%、53.5%及14.3%。淋巴结微小转移与病变浸润深度及癌细胞分化程度有关,而与年龄、性别、病变部位、病变长度及分期无关。淋巴结微转移和预后密切相关。结论:食管癌区域淋巴结确实存在普通光镜难以发现的微小转移,部分淋巴结阴性患者生存期短预后差原因可能与该患者存在淋巴结微小转移有关即"逆向预后",因此对食管癌手术标本应常规检测其淋巴结微转移,对存在淋巴结微转移者,术后给予相应的辅助治疗。Abstract: Objective: To investigate the expression of CK- 19 in the resected lymph nodes of esophageal carcinoma patients using FITC- labeled flow cytometry and to analyze the correlation between lymph node micrometastasis and prognosis. Methods: The CK-19 gene is expressed in esophageal epithelium and it is not expressed in normal lymph nodes. A total of l00 patients were selected randomly from those who underwent radical surgery for esophageal carcinoma from January 1998 to December 1999, and 1248 lymph nodes were collected from these patients to be assessed for CK- 19 expression by flow cytometry. Results: Two hundred and seventy- nine lymph nodes were confirmed to contain metastasis by both routine pathology and FITC- labeled flow cytometry. The other 969 lymph nodes without metastasis according to pathology were retested with FITC- labeled flow cytometry. Based upon the flow cytometry data, 156 lymph nodes from 28 patients showed micrometastasis(MM). The mi-crometastatic rate was 41.8%, and the micrometastatic degree was 16.1%. The 1-, 3-, and 5- year survival rates in MM(+) patients were 82.1%, 53.6%, and 14.3%, respectively. Micrometastasis was correlated with tumor cell differentiation and infiltrative depth of the tumor, and it was not correlated with age, gender distribution, and tumor stage. Lymph node micrometastasis was correlated with prognosis. Conclusion: Micrometastases, which cannot be detected microscopically, exist in the lymph nodes in the region of esophageal carcinoma. The poor prognosis of some patients without microscopically de-tectable metastasis was attributable to micrometastasis. We suggest that the detection of micrometastasis by FITC- labeled flow cytometry should be a standard procedure so that those patients with micrometas-tasis can receive proper treatment.
-
Keywords:
- FITC /
- Esophageal carcinoma /
- Lymph node micrometastasis /
- Micrometastasis
-
-
[1] 1 Izbicki JR,Hosch SB,Pichlmeier U,et al.Prognostic value of im-munohistochemically identifiable tumor cells in lymph nodes ofpatients with completely resected esophageal cancer [J].N Engl JMed,1997,337(17): 1188~ 1194
2 Natsugoe S,Mueller J,Stein HJ,et al.Micrometastasis and tumorcell microinvolvement of lymph nodes from esophageal squamouscell carcinoma: frequency,associated tumor characteristics,andimpact on prognosis[J].Cancer,1998,83(5): 858~ 866
3 Glickman JN,Torres C,Wang HH,et al.The prognostic signifi-cance of lymph node micrometastasis in patients with esophagealcarcinoma[J].Cancer,1999,85(4): 769~ 778
4 王 洲,刘相燕,刘凡英.食管癌淋巴结隐匿性转移的基因诊断 [J].中国癌症杂志,2002,12(4):317~ 319
5 王 洲,刘相燕,刘凡英,等.N 0 期食管癌术后早期复发与淋巴结微转移的相关性研究 [J].中华外科杂志,2004,42(2):68~ 71
6 张兆祥,朱忠尧.食管癌淋巴结微转移的研究进展 [J].中国肿瘤临床,2004,21(7):416~ 419
7 Rostagno P,Moll JL,Bisconte JC,et al.Detection of rare circulat-ing breast cancer cells by filtration cytometry and identification byDNA content: sensitivity in an experimental model [J].AnticancerRes,1997,17(4A): 2481~ 2485
8 顾 林,冯玉梅、 潘乐康,等.应用 RT- PCR 法检测 CK- 19 表达提高乳腺癌前哨淋巴结微转移检出的研究 [J].中国肿瘤临床,2004,31(3):144~ 148
9 张 逊.食管癌 TNM 分期的现状及发展趋势 [J].中华肿瘤杂志,2004,26(11):641~ 644
10 许运龙,郭昭扬.胸部食管癌转移淋巴结数与预后的临床研究 [J].中华肿瘤杂志,2000,22(3):244~ 246
11 Hermanek P,Hutter RV,Sobin LH,et al.International UnionAgainst Cancer.Classification of isolated tumor cells and mi-crometastasis[J].Cancer,1999,86(12): 2668~ 2673
计量
- 文章访问数: 3
- HTML全文浏览量: 0
- PDF下载量: 1
下载:
