目的 研究淋巴结微转移对结肠癌患者病理分期的影响.方法 对1120枚结直肠癌患者淋巴结进行常规HE染色和CK20、CEA免疫组化微转移的检测,并对结果进行统计学分析.结果 CK20检测出有微转移淋巴结103枚,占9.2％(103/1120),CEA检测出有微转移淋巴结88枚,占7.9％ (88/1120).CK20联合CEA检测出130枚淋巴结检出有微转移,占11.6％ (130/1120).肿瘤浸润愈深,微转移愈易发生(P＜0.05),分化程度低者,微转移阳性率高(P＜0.05).130枚淋巴结检出有微转移,13例TNM分期提高,其中Ⅰ期→Ⅲ期2例,Ⅱ期→Ⅲ期11例,HE染色重新分期率为18.6％ (13/70).结论 结直肠癌淋巴结免疫组化检测有助于更准确地进行结直肠癌的临床病理分期.%Objective To detect the rate of micrometastasis in regional lymph nodes and evaluate the significance of lymph node mi-crometastasis in determining PTNM staging in colorectal carcinoma. Methods In addition HE, immunohistochemical (IHC) for Cytokeratin-20 (CK20) and CEA were used to detect micrometastasis in 1 120 lymph nodes from 70 patients with colorectal carcinoma. Results In 1 120 regional lymph nodes,9. 2% (103/1 120) were positive for metastasis by CK20.7. 9% (88/1120) by CEA and 11. 6% (130/1120) by combined IHC examination. The difference in postive rate by metastasis among three groups was not significant ( P > 0.05 ). The presence of micrometastasis was closely correlated with invasion depth of primary tumor,tumor invasion deeper,slightly more prone to metastasis (P < 0. OS). Micrometastasis was also closely related to histological type and differentiation was lower,micrometastasis was higher (P<0. 05). Lymph node micrometastasis was further detected in 130 nodes. The rate of second HE staging was 18. 6% (13/70). 13 patients were upstaged (from I stage to W stage in 2 patients and from II stage to U stage in 11 patients). Conclusions IHC staining can increase the detection of lymph node metastasis and has a significant impact on the staging system of colorectal carcinoma. There are some values to reeval-uate clinical stage and predict recurrences, metastasis, prognosis, even can help clinical therapy.
展开▼
