王 涛, 杨熊飞, 张维胜, 王争霞①, 杨玉林②. Dukes B 期大肠癌前哨淋巴结微转移的定位检测及临床意义*[J]. 中国肿瘤临床, 2010, 37(16): 937-940. DOI: 10.3969/j.issn.1000-8179.2010.16.012
引用本文: 王 涛, 杨熊飞, 张维胜, 王争霞①, 杨玉林②. Dukes B 期大肠癌前哨淋巴结微转移的定位检测及临床意义*[J]. 中国肿瘤临床, 2010, 37(16): 937-940. DOI: 10.3969/j.issn.1000-8179.2010.16.012
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WANG Tao1, YANG Xiongfei1, ZHANG Weisheng1, WANG Zhengxia2, YANG Yuli3. Detection of Sentinel Lymph Node Micrometastasis in Dukes B Colorectal Carcinoma and Its Clinical Significance[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2010, 37(16): 937-940. DOI: 10.3969/j.issn.1000-8179.2010.16.012
Citation: WANG Tao1, YANG Xiongfei1, ZHANG Weisheng1, WANG Zhengxia2, YANG Yuli3. Detection of Sentinel Lymph Node Micrometastasis in Dukes B Colorectal Carcinoma and Its Clinical Significance[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2010, 37(16): 937-940. DOI: 10.3969/j.issn.1000-8179.2010.16.012
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Dukes B 期大肠癌前哨淋巴结微转移的定位检测及临床意义*

Detection of Sentinel Lymph Node Micrometastasis in Dukes B Colorectal Carcinoma and Its Clinical Significance

    摘要
  • 摘要: 目的：探讨大肠癌前哨淋巴结（sentinel lymph node ，SLN ）微转移（micrometastasis，MM）的检测方法及其临床意义。方法：前瞻性研究64例行根治性手术的Dukes B期大肠癌患者，对其中61例定位成功的122 枚SLN 应用常规HE染色联合免疫组化SP法，检测其前哨淋巴结中细胞角蛋白20（CK20）及端粒酶的表达，随访3 年，记录患者的临床病理参数和生存资料，分析其相关性。结果：1）61例中有6 例患者9 枚SLN 经常规HE检测阳性。2）免疫组化法检测SLN ：CK20阳性表达27.3%（15/55）；端粒酶阳性表达21.8%（12/55）。 3）两者联合检测前哨淋巴结微转移（SLNMM）检出率为38.2%（21/55）。 4）Dukes B期患者SLNMM（+）组癌复发转移率明显高于同期SLNMM（-）组（P<0.05），生存率较低（P<0.05），而与Dukes C期对比，差异无统计学意义；SLNMM（-）组患者的复发转移率、生存率与同期Dukes C期患者对比，有显著性差异（P<0.05）。 结论：CK20、端粒酶免疫组化法均可检测出大肠癌SLN 中存在的微转移（MM），两者联合可提高检出率；大肠癌SLNMM的检出使大肠癌的Dukes分期更加精细，从而有助于指导术后的辅助治疗和预后判断。

     

    Abstract: Objective:To investigate the detection of sentinel lymph node micrometastasis (SLNMM) in Dukes B colorectal carcinoma and its clinical significance.Methods: In a retrospective study, 122 SLNs were found and examined in 61of 64patients with Dukes B colorectal carcinoma through immunohistochemical detection of cytokeratin20(CK 20) and telomerase expression and HE staining. The patients were followed up for at least 3 years. The correlation between clinicopathologic parameters and patient survival was analyzed. Results: Of the 61patients examined, 9 SLNs from 6 different patients were positive by HE staining; 27.3% (15/55) of the cases which were negative in HE staining were positive for CK 20expression in immunohisto -chemical staining. Micrometastasis was also detected in 12cases (21.8%) by IHC anti-telomerase staining. Combining these 2 methods can improve the detection rate by up to38.2% (21/55). The rate of carcinoma recurrence or metastasis for Dukes B patients with SLNMM (+) was significantly higher than that of Dukes B patients with SLNMM (-) (P<0.05). But, the survival rate of patients with SLNMM (+) was significantly lower than that of patients with SLNMM (-). No significant difference was found in recurrence or metastasis rate and survival rate between Dukes B (+) patients and Dukes C patients. However, the recurrence or metastasis rate and survival rate were significantly different between Dukes C patients and SLNMM (-) Dukes B patients ( P<0.05). Conclusion:Immunohistochemical detection of anti-CK 20and anti-telomerase expression can detect micrometastasis in SLNs. It is a valuable tool for staging Dukes, selection of adjuvant therapy and evaluation of prognosis of colorectal carcinoma patients.

     

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