直肠癌淋巴结微转移标志物的比较研究

目的：评价直肠癌淋巴结CK20、CK19、CEA诊断微转移的敏感性、特异性，探讨微转移的临床病理意义。方法：采用免疫组织化学染色方法，以CK20、CK19、CEA为指标，检测36例直肠癌患者手术区域252枚淋巴结的微转移，对照组为淋巴结反应性增生的标本15例。结果：常规HE检测淋巴结转移阳性率7．94％，CK19、CK20、CEA阳性率分别为20．63％、23．02％、17.46％，均高于HE检测结果（P〈0．01）。三种抗体在淋巴结微转移阳性率存在统计学差异。19枚对照组淋巴结CK19阳性率47.37％，CEA阳性率10．53％．CK20表达阴性。CK20、CK19、CEA淋巴结微转移阳性率与3年复发率无统计学差异（P〉0.05）。结论：对常规病理检测未发现区域淋巴结转移的直肠癌，有必要辅以免疫组化方法检测其微转移，CK20是首先标志物。

Significance of CK20,CK19 and CEA for Detecting Lymph node Micrometastasis in Rectal Carcinoma

Objective: To evaluate the sensitivity, specificity and clinical signi ficance of CK20,CK19 and CEA for detecting micrometastasis by sampling regional lymph nodes of rectal carcinoma. Methods:36 cases of rectal carcinoma together with 252 lymph nodes were studied.Histologic sections were stained with HE and immunostained with antibody against CK20,CK19 and CEA. Lymph nodes of 15 patien ts with reactive hyperplasia(RH) served as control. Results:In 252 regional lym ph nodes from rectal carconoma ,20(7.94%) were positive for metastasis by histop athological examination, 52(20.63%) by CK19,58(23.02%)by CK20 and 44(17.46%) by CEA.The positive rate by immunohistochemical examination significantly higher th an that by HE(P<0.01). In the 19 lymph nodes from patients with RH, 9(47 .37%) for CK19 and 2(10.53%) for CEA, but none expressed CK20.There was no correlation between 3 years recurrence rate and micrometastatic postive rate of CK 20,CK19 and CEA(P>0.05).Conclusion:The detection of lymph node micrometastases by immunohistochemical method is necessary for the patients with node negative carcinoma.CK20 is a more specific marker than CK19 and CEA.