早期胃癌淋巴结微小转移的临床病理学及生物学特征研究

目的:研究早期胃癌淋巴结微小转移的临床病理学及生物学特征,探讨微小转移的诊断、治疗及其预后,阐明早期胃癌淋巴结转移发生、发展机理。方法:以11例有微小淋巴结转移者作为微小转移组,以46例有淋巴结转移者作为对照组。应用免疫组织化学染色检测ssDNA、bcl-2、p53、c-myc、E-cadherin、Ki-67和CD34。将各组的肿瘤灶亚分类为表层部、浸润部和淋巴结部,对各病例的各部位、各个指标进行统计学分析。结果:微小转移组中表层部的ssDNA阳性率高于对照组、浸润部和淋巴结部,bcl-2的阳性率高于浸润部和淋巴结部,c-myc阳性率高于对照组;其淋巴结部的E-cadherin阳性率和微血管面积比低于对照组;其表层部和淋巴结部的Ki-67阳性率低于对照组。微小转移组中淋巴结等于或小于4mm者占27.3%。结论:ssDNA、E-cadherin和Ki-67低表达的早期胃癌癌细胞恶性程度较高,黏附力较低,但增殖能力较弱,部分处于静止状态;而微血管增加是转移灶形成和发展的基础。

Clinicopathological and biological features of micrometastasis in early gastric cancers

OBJECTIVE: To investigate the clinicopathological and biological features of micrometastasis in early gastric cancers. METHODS: Eleven cases of early gastric cancer with micrometastasis (micrometastatic, MM group) and 46 cases of early gastric cancer with lymph node metastasis (control group) were included in the study. Immunochemical staining of ssDNA, bcl-2, p53, E-cadherin, Ki-67, CD34 was performed. The superficial lesions, invasive fronts and lymph nodes were examined in both groups. RESULTS: Positive rate of ssDNA at the superficial lesions in MM group was higher than that in control group. In MM group the positive rate of ssDNA in micrometastasis was higher than that at invasive fronts and in lymph nodes. Positive rate of bcl-2 at the superficial lesions in micrometastasis was higher than that at invasive fronts and lymph nodes. Positive rate of c-myc at the superficial lesions in MM group was higher than that in control group. Positive rate of E-cadherin and the percentage of microvascular areas at the lymph nodes in MM group was lower than those in control group. Proliferative ability of cancer cells at superficial lesions and lymph nodes in MM group was lower than those in control group. Lymph nodes <3 mm in micrometastasis accounted for 27.3%. CONCLUSION: The pathological and biological features of micrometastasis in early gastric cancer show low positive rate of ssDNA, E-cadherin, Ki-67 and low percentage of microvascular areas at the lymph nodes.