CK20在检测结直肠癌淋巴结微转移中的临床意义

目的：研究PT1-4N0M0结直肠癌患者术后病理因素和淋巴结微转移对5年无瘤生存率的影响。方法：纳入PT1-4N0M0结直肠癌126例,均行结直肠癌根治术,用免疫组化染色术后平均随访64.11（64~106）个月。观察临床病理因素及微转移对术后5年无瘤生存率的影响进行统计分析。结果：临床病理因素中,＂淋巴管浸润＂及＂侵袭肠壁深度＂与CK20的表达呈正相关,而其它临床病理因素与淋巴结的CK20表达无明显相关性。临床病理因素与5年无瘤生存率均无明显相关性。在淋巴结CK20表达阴性、孤立肿瘤细胞巢（isolated tumor cells,ITCs）和微转移（micrometastasis,MCM）的患者中,5年无瘤生存率分别为75.6%、63.5%和50.0%。ITCs和CK20（-）患者5年无瘤生存率差异无统计学意义（P=0.119）,而MCM与CK20（-）患者,5年无瘤生存率差异有统计学意义（P=0.010）。结论：对于PT1-4N0M0期结直肠癌患者,若淋巴结中检测出微转移,其预后较差,术后复发率较高,应予以积极的术后辅助综合治疗。

Clinical Significance of Lymph Node Micrometastasis of Colorectal Cancer Detected by CK20 ImmunohistoChemistry

Objective：This study was designed to evaluate the prognostic impact of a wide spectrum of pathologic parameters in a consecutive series of homogenously treated and well-characterized patients with PT1-4N0M0 colorectal cancer,and the prognostic value of lymph node occult disease（micrometastasis） in disease-free survival rate.Methods： 126 with PT1-4N0M0 colorectal tumors were enrolled.The average postoperative follow-up was 64.11（64~106） months.At least 10 lymph nodes were harvested and examined in all the specimens.The prognostic value of 10 pathologic parameters,including lymph node occult disease（micrometastasis）,was investigated.Results： Multivariate analysis identified lymphatic vessel invasion（absent or present;P=0.037） and depth of tumor invasion（T1,T2,T3 or T4;P=0.019） were positwely correlated with CK20 expescion.There was no significant correlation difference between pathologic parameters and the five-year disease-free survival rates.The five-year disease-free survival rates were 75.6,63.5 and 50.0 percent for the lymph node negative,isolated tumor cells and micrometastasis groups,respectively.There was significant difference between the lymph node negative and micrometastasis groups（P=0.010）,However,There were no diference between the lymph node negative and isolated tumor cells groups（P=0.119）.Conclusions： We propose that patients found micrometastasis in lmphy node with high-risk PT1-4N0M0 colorectal cancer for whom adjuvant combined therapy may be justified and effective.