肺癌淋巴结微转移灶检测的分期及预后价值

目的 通过免疫组织化学的方法检测非小细胞肺癌患者术后常规病理检查为阴性淋巴结的徽转移灶，研究其对分期的影响。方法 以行肺癌根治性手术的39例患者为对象，采用免疫组织化学角蛋白(CK)染色的方法检测术后常规病理学检查为阴性淋巴结中的微转移灶，研究其检出对分期的影响。结果 在39倒患者的90枚阴性淋巴鳍中，22例患者(56．4％)的26枚淋巴结(28．89％)检出微转移灶。常规临床分期N0期中，有淋巴结微转移灶患者的生存期（27个月)与无淋巴结微转移灶者(57个月)的差异有显著性(P=0．0246)；而N0、N1期有淋巴结微转移灶患者的生存期与N2期无淋巴结微转移灶者的差异无显著性(P=0．93)。有复发转移(81％)与无复发转移(39％)患者的淋巴结微转移率的差异有显著性(P=0．02)；有、无微转移灶患者的生存期分别为32和48个月、3年生存率分别为35％和75％(P=0．0178)。结论 目前常规的肿瘤TMN分期方法存在一定缺陷，而淋巴结微转移灶的检测将有助于更精确的分期。淋巴结微转移灶的检测可作为非小细胞肺癌患者手术后的一个重要预后指标。

Detection of micrometastasis in lymph nodes of patients with non-small-cell lung cancer: Its impact on staging and prognosis

Objective This study was designed to estimate the impact on staging by detection of micrometastasis. Methods Specimens from 90 regional lymph nodes indicated to be tumor free by conventional histopathologic methods were taken from 39 patients who underwent pulmonary resection for non small cell lung cancer(NSCLC). These Specimens were fixed in formalin and embedded in parafin. CK immunohistochemical staining was used to detect the micrometastatic tumor cells in lymph nodes. Results Micrometastasis were found in 26 lymph nodes(28.89%) of 22 patients(56.4%). Comparision between patients with the tumor staged as N 0 or N 1 with nodal micrometastases and control patients with pathologically proved N2 stage tumor without nodal micrometastases, revealed no stastitical difference in total survival period. The duration of survival of patients with micrometastasis was significantly shorter than that of patients without micrometastasis (32 months vs. 48 months, P =0.0178). Conclusion The conventional TNM staging method has certain drawbacks and is inadequate for precise staging of NSCLC.