细胞角蛋白在检测胃癌淋巴结微转移中的应用价值

方法：选取50例经常规病理学检查无淋巴结转移的胃癌根治术后患者的胃周淋巴结的常规石蜡包埋组织块242个，分别应用免疫组织化学方法检测HE染色和癌胚抗原（CEA）、细胞角蛋白（CK19、CK20）的表达。随访患者28例，随访时间48～90月。结果：242个淋巴结常规HE染色均为阴性。经免疫组织化学染色后，有11例患者（22%）、18个淋巴结（7.44%）发现微转移，CEA、CK19、CK20表达阳性的淋巴结数分别为10、17、16个。CEA检出微转移患者6例。CK19和 CK20检出微转移患者均为10例。28例随访患者中，复发及死亡组微转移阳性率（3/7）明显高于无复发组（2/21）。微转移阳性组无病生存期明显短于阴性组，而总生存期无显著性差异。结论：CEA、CK均可用来检测胃癌淋巴结微转移，但CK比CEA敏感性高。CK20与CK19在检测淋巴结微转移方面有相同的敏感性，CK20具有更强的特异性。胃癌淋巴结微转移阳性者复发和死亡率高。

Role of cytokeratin in determining the lymph node micrometastasisin gastric carcinoma

Objective:To investigate the role of cytokeratin in determining the lymph node micrometastasis in node-negative gastric carcinoma with anticytokeratin antibody.Methods:Two hundred and forty-two dissected lymph nodes from 50 patients with node-negative gastric carcinomas were examined with hematoxylin and eosin(HE),antihuman CEA(carcinoembryonic antigen) antibody,anti-cytokeratin 19(CK19) antibody and anti-cytokeratin 20(CK20) antibody.Of them,28 patients were followed up for 48 to 90 months.Results: Micrometastases were identified in 11 of 50 patients(22%) and in 18 of 242 lymph nodes((7.44%)) by immunohistochemical staining.Positive reactions were found in 10 lymph nodes(4.13%) stained with CEA,and in 17((7.02%)) or 16(6.61%) stained with CK19 or CK20.No lymph node stained by HE showed positive result.A higher incidence of micrometastasis was found in the patients with recurrent disease((42.86%,) 3/7) compared with result from recurrence-free patients(9.52%,2/21).Survival analysis demonstrated that the disease-free survival time in micrometastasis positive patients was shorter than that of the negative ones.But there was no significant difference of the cumulative survival rate.Conclusions:CK is a more sensitive marker than CEA for detection of metastases,and the specificity of CK20 is better than CK19 in this assay.Micrometastases might correlate with worse prognosis for patients with histologic node negative gastric cancer.