常规检查淋巴结阴性No.7组胃癌患者的淋巴结微转移研究

目的探讨常规病理检查无淋巴结转移的胃癌淋巴结微转移的特点,并分析微转移与各种临床病理因素的关系.方法应用淋巴结组织连续切片和端粒酶 RT-PCR ELISA方法检测 46例胃癌患者常规病理检查无淋巴结转移的 No.7组淋巴结 138个,并结合胃癌患者的临床病理资料进行统计学分析.结果本组 13例(28.3%) 32枚淋巴结(23.2%)经连续切片检出有微转移;而端粒酶阳性表达为 20例(43.5%) 49枚淋巴结(35.5%).端粒酶 RT-PCR ELISA检测敏感性为 100%,特异性为 84%,阳性预测值为 65%,阴性预测值为 100%,诊断准确率为 88%.淋巴结微转移与患者年龄、性别、原发肿瘤部位、组织学类型和转移淋巴结分型无关(P >0.05),但与原发肿瘤大体类型、大小及是否浸透浆膜有关(P< 0.05).结论对常规病理检查无淋巴结转移的胃癌患者,为客观评价胃癌临床病理分期及其预后,有必要监测其微转移,端粒酶 RT-PCR ELISA方法可以作为传统组织学检查方法的补充.

Study on No.7 lymph nodes micrometastasis in patients with node-negative gastric carcinoma by routine examination

OBJECTIVE: To investigate the micrometastatic characteristics in the gastric cancer patients with negative lymph node invasion by routine pathological examination and evaluate the relationship between micrometastasis and clinicopathological features. METHODS: One hundred and thirty-eight lymph nodes from No. 7 group in 46 patients with node-negative gastric cancer by routine examination were examined by consecutive sections. Telomerase activity was determined by RT-PCR and ELISA. Clinicopathological data were analyzed by statistical method. RESULTS: Micrometastasis was found in 32 lymph nodes (23.2%) from 13 cases (28.3%) by consecutive sections. Telomerase activity was positive in 49 lymph nodes (35.5%) from 20 cases (43.5%). The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of TRAP-ELISA was 100%, 84%, 65%, 100% and 88% respectively. The micrometastasis in lymph node was correlated with age, sex, primary tumor location, histological classification and metastatic lymph node type (P> 0.05), but correlated with the gross type of the primary tumor, size and serosa invasion (P< 0.05). CONCLUSIONS: It is necessary to discern the micrometastasis in gastric cancer with negative lymph node by routine examination in order to objectively evaluate the clinicopathological classification and prognosis. TRAP-ELISA can be a complementary method to traditional histological examination.