细胞角蛋白7、18、19在壶腹周围癌淋巴结微转移灶的检测及临床意义

目的探讨细胞角蛋白对壶腹周围癌淋巴结微转移的检出率,并分析淋巴结微转移与临床预后的关系,为提高临床综合疗效提供理论依据。方法应用细胞角蛋白(CK7、CK18、CK19)单克隆抗体,对45例壶腹周围癌根治术后经病理常规HE染色阴性的186枚淋巴结进行免疫组织化学技术(S P法)检测,结合随访资料进行临床预后分析。结果45例壶腹周围癌根治术后HE染色阴性的186枚周围淋巴结中,有9例(20%、9/45)34枚(18.3%、34/186)淋巴结中检出微小转移灶。免疫组化诊断微转移阳性组和阴性组的1年复发率分别是88.9%(8/9)和16.7%(6/36),两组间有显著性差异(P<0.05)。不同单克隆抗体(CK7、CK18、CK19)检测发现,CK19在壶腹周围癌186枚淋巴结的检出率高达15.6%(29/186),CK19与壶腹周围癌淋巴结微转移关系密切(P<0.05)。结论对常规病理检查阴性的壶腹周围癌淋巴结进行CK7、CK18、CK19检测有助于发现微转移灶,为提高淋巴结微转移诊断的准确性、判断临床分期、估计预后及选择辅助治疗提供理论依据。CK系列单抗联合检测可提高淋巴结微转移阳性检出率。

Expression of CK7, CK18, CK19 in lymph nodes of periampullary carcinoma and their clinical significance

Objective To probe the relationships between detection rates of CK7, CK18 and CK19 in lymph nodes of periampullary carcinoma and clinical prognosis of the diseases. Methods The expressions of CK7, CK18, CK19 were examined by Immunohistochemical methods (S-P) in 186 HE-straining-negative lymph nodes from 45 periampullary carcinoma cases with the monoclonal antibodies of CK7, CK18 and CK19. Results Micrometastasis were found in 34 lymph nodes (18.3%) of 9 periampullary carcinoma cases whose HE staining results were negative (20%), among which, 8 cases died from local recurrence and distal metastasis in one year. 1-year-recurrent rate of micrometastasis immunohistochemical straining positive group and negative one was 88.0% and 16.7%, respectively, and there was significant difference (P<0.05). By detecting the expressions of CK7, CK18, CK19 in lymph nodes, it was found that CK19 correlated with micrometastasis in lymph nodes of periampullary carcinoma. The detection rate of CK19 was 15.6% in 186 lymph nodes from periampullary carcinoma. Conclusions Micrometastatic cancer cell can be easily found by immunohistochemical staining of tumor specific antibodies (CK7, CK18, CK19), which is of importance in predicting prognosis and guilding clinical therapy.