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目的 :Dukes B期大肠癌患者手术后 5年生存率为 5 3 9%～ 84 9% ,有部分患者 5年内出现局部复发或 /和远处转移。本研究旨在探讨淋巴结微小转移灶 (lymphnodesmicrometastasis,LMM )的表达对评估经手术切除原发肿瘤及肠周淋巴结的Dukes B期大肠癌患者预后的重要性和指导术后治疗的意义。方法 :收集 5 2例Dukes B期大肠癌患者手术切除的淋巴结石蜡标本 ,同时获得这些病例的临床资料及随访 (生存期大于 5年或死亡 )资料 ;实验方法 :以细胞角蛋白单抗 (anti cytokerratinAE1/AE3)为探针 ,采用免疫组化SAP(streptavidin alkalinephosphatase)法检测淋巴结中的LMM。 结果 :测 5 2例Dukes B期大肠癌患者的淋巴结中LMM +组 11例(2 1 15 % ) ,LMM 组 41例 (78 85 % )。在 38例生存期大于 5年的患者中LMM +占 13 2 % (5 / 38,)LMM 占86 8% (33/ 38)。χ2 检验P <0 0 5 ,生存分析log rank检验P <0 0 5 ;说明LMM +组的生存期明显短于LMM 组。本实验中一般因素 (性别、年龄及肿瘤所在部位 )对LMM检测结果的影响不明显 ;统计学处理 ,P >0 0 5。结论 :用免疫组化法检测Dukes B期大肠癌患者经手术切除后肠周淋巴结中的微小转移灶对判断患者预后及指导术后治疗均有意义 ,值得在临床应用。
OBJECTIVE: The 5-year survival rates of patients with Dukes B colorectal cancer after operation were 53.9% ~ 84.9%. Some patients had local recurrence and / or distant metastasis within 5 years. This study aimed to investigate the significance of the expression of lymph node micrometastasis (LMM) in evaluating the prognosis of patients with Dukes B stage colorectal cancer after primary resection of primary tumor and intestinal lymph nodes and the significance of postoperative treatment. Methods: Lymphatic paraffin specimens were collected from 52 patients with Dukes B stage colorectal cancer. Clinical data and follow-up (survival> 5 years or death) of these patients were also obtained. Methods: cytokerratinAE1 / AE3) was used as a probe to detect LMM in lymph nodes by using streptavidin alkaline phosphatase (SAP) method. RESULTS: Eleven patients (21.15%) in LMM + group and 41 (78.85%) patients in LMM group were detected in 52 patients with Dukes B colorectal cancer. LMM + accounted for 13.2% (5/38) of LMMs in 38 of 38 patients with survival of more than 5 years (86.8%, 33/38). Chi-square test P <0 05, survival analysis log rank test P <0 05; LMM + group survival was significantly shorter than the LMM group. In this experiment, the general factors (gender, age and tumor site) have no obvious effect on the LMM test results; Statistical analysis, P> 0.05. Conclusion: Immunohistochemical detection of micrometastases in the peritumoral lymph nodes of patients with Dukes B stage colorectal cancer after surgical resection is of great value in judging prognosis and guiding postoperative treatment, which is worthy of clinical application.