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目的研究淋巴结微转移及临床病理因素对pT1～3N0期胃癌患者术后5年无瘤生存率的影响。方法纳入我院2000年1月至2004年12月期间pT1～3N0期胃癌患者行根治术者120例2106枚淋巴结,每例患者淋巴结9～28枚,平均18枚,所有淋巴结经HE染色均为阴性。应用免疫组化染色法检测淋巴结中CK20表达,并分析胃癌患者的临床病理特征及胃癌淋巴结中CK20表达对5年无瘤生存率的影响。结果经免疫组化染色,有9.07%(191/2106)的淋巴结出现CK20阳性表达;有26.67%(32/120)患者的淋巴结中出现CK20阳性表达,其中11例(9.17%)为微转移,21例(17.50%)为孤立肿瘤细胞巢(ITC)。术后随访24～121个月(平均66.35个月)。淋巴结中CK20阴性表达、ITC和微转移的患者,5年无瘤生存率分别为87.4%、78.3%和40.9%。5年无瘤生存率在淋巴结CK20出现微转移者中明显低于CK20阴性表达者(P=0.000)和以ITC为特征者(P=0.046),而仅以ITC为特征者与CK20阴性表达者间比较,差异无统计学意义(P=0.253)。淋巴结中CK20阳性表达与胃癌患者的肿瘤直径(P=0.011)、浸润胃壁深度(P=0.043)和是否有淋巴管浸润(P=0.002)有关。所有临床病理因素对5年无瘤生存率均无明显影响(P>0.05)。11例胃癌患者被检测出微转移,应划分为pN1(Mi)期,本组重新分期率9.17%。而88例胃癌患者淋巴结CK20(-)和21例表达为ITC,分别被记为pN0(i-)和pN0(i+),不建议重新分期,仍为pN0期。结论对于pT1～3N0期胃癌,若淋巴结中检测出微转移,其预后较差,术后5年无瘤生存率较低,建议术后应予以积极的辅助治疗。
Objective To investigate the effect of lymph node micrometastasis and clinicopathologic factors on 5-year disease-free survival of patients with gastric cancer of pT1 ~ 3N0. Methods Totally 2106 lymph nodes were included in 120 cases of patients with gastric cancer of pT1 ~ 3N0 from January 2000 to December 2004, with 9 ~ 28 lymph nodes in each patient, with an average of 18 on average. All the lymph nodes were stained with HE negative. Immunohistochemical staining was used to detect the expression of CK20 in lymph nodes, and to analyze the clinicopathological features and the expression of CK20 in lymph node of gastric cancer on 5-year disease-free survival rate. Results Immunohistochemical staining showed positive CK20 expression in lymph nodes of 9.07% (191/2106). CK20 expression was found in lymph nodes of 26.67% (32/120) patients, of which 11 (9.17%) were micrometastases, Twenty-one cases (17.50%) were isolated tumor cell nests (ITC). The patients were followed up for 24 to 121 months (mean, 66.35 months). CK20 negative expression in lymph nodes, ITC and micrometastasis in patients with 5-year disease-free survival rates were 87.4%, 78.3% and 40.9%. 5-year disease-free survival was significantly lower in patients with CK20 micrometastases than in those with CK20 negative expression (P = 0.000) and ITC (P = 0.046), but only with ITC and CK20 negative expression There was no significant difference between the two groups (P = 0.253). The positive expression of CK20 in lymph nodes correlated with tumor diameter (P = 0.011), infiltration of gastric wall depth (P = 0.043) and lymphatic invasion (P = 0.002). All clinicopathological factors had no significant effect on 5-year disease-free survival (P> 0.05). 11 cases of gastric cancer were detected micrometastases, should be divided into pN1 (Mi) period, the group of 9.17% re-staging rate. However, CK20 (-) and 21 cases of lymph node in 88 cases of gastric cancer were expressed as ITC, which were respectively marked as pN0 (i-) and pN0 (i +). Conclusions For patients with pT1 ~ 3N0 gastric cancer, if the micrometastases were detected in the lymph nodes, their prognosis is poor and the 5-year survival rate is low. It is suggested that they should be actively adjuvant after the operation.