多株单克隆抗体检测胃癌阴性淋巴结微转移的研究及临床意义

目的:探讨单克隆抗体联检在诊断胃癌阴性淋巴结微转移中的应用价值。方法:选择鼠抗人细胞角蛋白(CK)-19单克隆抗体,鼠抗人上皮膜抗原(EMA)单克隆抗体,鼠抗人癌抗原CA72-4(TAG-72)单克隆抗体采用免疫组化法对65例可切除性胃癌患者的385枚阴性淋巴结进行微转移阳性表达检测,对相关临床病理因素及预后进行统计。结果:三种单克隆抗体联检出17例(26.2%)胃癌的33枚(8.6%)淋巴结有微转移。弥漫型胃癌的淋巴结微转移度(38.9%)明显高于肠型胃癌(10.4%)。淋巴结微转移与肿瘤侵袭胃壁深度有关。有微转移的5年生存率(65.3%)明显低于无转移者(87.4%),预后较差。结论:单克隆抗体联检可以提高胃癌淋巴结微转移检出度,提高临床病理分期准确性,指导术后综合治疗,判断预后。

The Combined Detection of Monoclone Antibodies on Micrometastases of the Lymph Nodes in Patients with Gastric Carcinoma

Objective:To study the diagnosis value of combined detection with Monoclone antibodies of micrometastases of the lymph nodes in patients with gastric carcinoma.Methods:We studied 385 negative lymph nodes removed during surgery for 65 cases of gastric carcinoma.Four consecutive sections were newly prepared from every negative lymph nodes for hematoxylin and eosin staining and immunohistochemical staining(IHC) with antibody against Cytokeratin19,Epithelial membrane antigen and Carbohydrate antigen724,respectively.Associations between clinicopathologic factors,the presence of micrometastases as well as micrometastases and survival were sought.Results:Micrometastases were identified in 17 of 65 patients(26.2%) and in 33 of 385 lymph nodes(8.6%) by IHC.The incidence of micrometastases was significantly higher in patients with diffuse type(12 of 35 cases,34.3%)then intestinal type(5 of 30 cases,16.7%,P<0.01).The presence of micrometastases was closely correlated with invasion depath of primary tumor.The 5-year survival rate after surgery was 65.3% and 87.4%,in patients with and without micrometastases(P=0.012),respectively.Other clinicopathologic findings had no statistically significant correlation with the incidence of micrometastases.Conclusion:The combined detection with Monoclone antibodies of lymph node micrometastases was useful to more accurately determine the clinical staging,prognosis and postoperation treatment with node-negative gastric carcinoma.