常规检查淋巴结阴性胃癌的淋巴结微转移研究

目的 研究常规病理检查无淋巴结转移的胃癌之淋巴结转移的特点，分析微转移与各种临床病理因素及预后的关系。方法 选用抗低分子量细胞角蛋白抗体ＡＥ１，运用免疫组化方法，检测１０５例常规病理检查无淋巴结转移的胃癌根治根本的胃周淋巴结１２４５个，并进行统计处理。结果 ３１例（２９．５％）胃癌的８１个淋巴结（６．５％）出现微转移。弥漫型胃癌的淋巴结微转移阳性率（４１．５％，２２／５３）明显高于肠型胃癌（１７．

Detection and significance of lymph node micrometastases in patients with histologically node negative gastric carcinoma

OBJECTIVE: To study micrometastasis in lymph nodes from patients with node-negative gastric carcinoma according to routine histologic examination and its relevance to prognosis. METHODS: A total of 1,245 perigastric lymph nodes histologically free of metastasis from 105 patients were immunohistochemically stained with monoclonal antibody AE1 against low molecular weight cytokeratin for micrometastases. RESULTS: Micrometastases were observed in 81 lymph nodes(6.5%) of 31 patients (29.5%). The incidence of lymph node micrometastases was significantly higher in the diffuse type(22 of 53 cases, 41.5%) than in the intestinal type of gastric carcinoma (9 of 51 cases, 17.6%, P < 0.01). The presence of micrometastases was closely correlated with the size and invasion depth of primary tumor, but was not correlated with age, sex and location of the primary tumor. The 5-year survival rate after surgery was 61.3% and 82.4%, respectively in patients with and without micrometastases (P = 0.0116). When the number of lymph node with micrometastases was > or = 3, the 5-year survival rate significantly decreased. CONCLUSION: The detection of lymph node micrometastases is necessary to more accurately determine the clinical staging and prognosis of patients with node-negative gastric carcinoma by routine histologic examination.