CK19表达及其在结肠癌淋巴结微转移诊断中的应用

目的：研究用免疫组化方法检测CK19及其在结肠癌淋巴结微转移诊断中的应用与临床病理意义。方法：取材于50例结肠癌病人肿瘤组织及癌周淋巴结255枚，同时进行HE染色组织学检查和抗角蛋白19抗体的免疫组化检测。结果：50例结肠癌组织中CK19表达均为阳性。255枚淋巴结用HE染色检查阳性者56枚(22．0％)，皆同时表达CK19阳性；另20枚淋巴结HE染色阴性，而CK19表达阳性。50例中有12例淋巴结中发现微转移，其中6例常规组织学检查属淋巴结转移阴性而免疫组化染色诊断表现为转移阳性。占常规病理检查淋巴结转移阴性者的21．4％(6／28)。随着肿瘤分期增加,淋巴结CK19表达阳性率亦增加。CK19表达阳性者预后较阴性者为差。结论：CK19免疫组化法是检测结肠癌淋巴结微转移的敏感而便捷的方法，而检测结肠癌微转移有助于判断肿瘤进展程度与预后。特别对在筛选组织学检查淋巴结阴性但存在微转移的病人有实用价值。

Significance of CK19 Expression in Detecting Lymph Node Micrometastases in Patients with Colon Carcinoma

ObjectiverTo evaluate the significance of CK19 expression in diagnosing micrometastases of lymph nodes in patients with colon carcinoma. Methods: Fifty cases of colon carcinoma together with 255 mesenteric lymph nodes were studied, histologic sections of the primary tumor and regional lymph nodes were stained with hematoxylin and eosin (HE) and immunostained with antibody against cytokeratin 19(CK19). Results: In all the cases, CK19 was positively expressed in the primary lesions. Among 255 lymph nodes, metastases were confirmed by HE in 56 lymph nodes(22.0%), and in 76 lymph nodes(29.8%) stained with immunohistochemistry, micrometastases were found in 20 lymph nodes. In the whole series, 12 cases showed lymph node micrometastasis by both staining methods, while another 6 patients showed microme tastases only by immunohistochemistry(21.4%) of 28 patients with negative findings by HE staining. Micrometastasis in the lymph nodes were significantly related to the Dukes' staging. Conclusions: Immunohistochemical staining is a valuable method for the detection of lymph node micrometastases in patients with colon carcinomas. Lymph nodes micrometastasis is significantly correlated with tumor staging.