癌症病人切除淋巴结内隐匿性微小癌转移灶的免疫组化研究

经常规病理检查切除淋巴结内无癌转移的350例早期癌症病人(肺癌94例、乳腺癌112例、食管癌115例及外阴癌29例)3 715枚淋巴结,用连续切片、免疫组化染色重新检查、单克隆抗细胞膜(EMA)、抗细胞角蛋白(AEI/AE3)、多克隆抗角蛋白抗体免疫染色,查出部分淋巴结内存在微小癌灶或/及单个癌细胞.肺癌病人阴性率为56.4%(53/94 ),淋巴结为16.6%(123/739);乳腺癌病人阳性率为27.7%(31/112),淋巴结为2.72%(50/1840);食管癌病人阳性率为22,6%(26/115),淋巴结为7.0%;处阴癌病人阳性率为10.3%,淋巴结为1.4%.所有癌症病人总阴性率为32.3%,淋巴结为5.5%.肺鳞癌病人阳性率(58.0%)大大高于食管鳞癌(22.5%)与外阴鳞癌(10.3%)(P<0.05);肺腺癌病例阳性率(53%)也明显高于乳腺腺癌(P<0.05).随访材料显示局部淋巴结内存在隐匿性很小癌灶的病例预后较差(P<0.05).研究结果表明:应用连续切片及免疫组化染色可大大提高淋巴结内微小癌灶的检出率.淋巴结内隐匿性微小癌灶可能是恶性肿瘤广泛扩散的第一步.若能在外科手术时尽可能清除这类淋巴结,或许可以防止癌广泛转移、播放.从而能更有效地控制恶性肿瘤以提高治愈率.

An Immunohistochemical Study on Occult Tumor Cells in Resected Lymph Nodes of Cancer Patients

3 715 resected lymph nodes (LN ) contained no metastatic tumor by conventional histopathological examination from 350 patients with different early carcinomas including non - small cell lung carcinoma (NSCLC) 94, breast carcinoma 112, esophageal carcinoma 115, and vulvar carcinoma 29, were re-examined by immunohistochemistry. The results showed:in 56. 4% NSCLC patients (53/94) and 16. 6% LN (123/739) ,27. 7% breast cancer patients (31/112) and 2.72% LN (50/1 840),22. 6% esophsgeal cancer patients (26/115) and 7.0% LN (27/381),and 10. 3% vulvar cancer patients (3/29) and 1.4% LN (3/216), and 32. 3% all cancer patients (113/350) and 5. 5% all examined LN (203/3 715)) micro metastases and/or single cancer cell were found. The incidence of immunostaining positive tumor cells in LN in squamous cell carcinoma (58. 0%),adenocarcinoma (53. 8%) of NSCLC patients was higher than those in esophageal and vulvar squamous cell carcinoma and breast adenocarcinoma (P<0. 005). The frequency in LN was a similar patterns. The data suggested that combined consecutive sections and immunostaining will greatly increase the yield of occult micrometastases in resected LN; the micrometastatic tumor may be the primary step for the further wild dissemination of malignant cells; The rapid metastases and high death rate of lung cancer may be related to,at least partial,the occult metastases;the involved LN were resected as can as possible at surgical therapy as a preventive tumor dissemination will have good outcome.