胃癌淋巴管生成、淋巴管浸潤及淋巴結微轉移的臨床意義_《中國普外基礎與臨床雜志》

作者：

姜波健 ¹ , 吳巨鋼 ¹ , 俞繼衛 ¹ , 李小強 ² , 卞邦健 ¹ , 張彪 ¹ , 倪曉春 ¹

關鍵詞：

D2-40 淋巴管生成淋巴結微轉移細胞角蛋白胃新生物

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目的探討胃癌淋巴管生成、淋巴管浸潤及淋巴結微轉移的臨床意義。方法免疫組化法檢測68例胃癌原發灶中D2-40的表達及其中 51例胃癌的791枚淋巴結中CK20和CKpan的表達，結合患者的臨床病理特征進行綜合分析。結果胃癌HE染色淋巴管浸潤（LVI-HE）和D2-40染色淋巴管浸潤（LVI-IM）的陽性率分別為66.2%（45/68）和76.5%（52/68），差異無統計學意義(P=0.118)。LVI-IM陽性率與腫瘤浸潤深度（P=0.044）、TNM分期（P=0.003）及存在淋巴結轉移(P=0.000)有關。68例胃癌平均淋巴管密度（LVD）為（18.19±7.44）個/HP。 LVD升高與LVI-HE陽性（P=0.040）、LVI-IM陽性（P=0.001）、靜脈浸潤（P=0.037）、TNM分期較晚（P=0.020）及存在淋巴結轉移（P=0.001）有關系。LVD值≥15個/HP者近期生存率較LVD值≤14個/HP者明顯降低（P=0.032）。51例胃癌HE染色和CK（CK20或CKpan）染色檢出淋巴結轉移率分別為74.5%（38/51）和88.2%（45/51），791枚淋巴結的轉移淋巴結檢出率由HE染色的32.0%（253/791）提高到CK染色的41.5%（328/791），P＜0.001。CKpan的微轉移檢出率明顯高于CK20（P=0.003）。微轉移淋巴結數量與腫瘤大小（P=0.001）、LVI-HE（P=0.040）、腫瘤浸潤深度（P=0.018）及TNM分期（P=0.012）有關。微轉移淋巴結的檢出使淋巴結轉移站別及TNM分期遷移： 7例N0→N1，6例N1→N2，1例N2→N3； 4例Ⅰb→Ⅱ，4例Ⅱ→Ⅲa，3例Ⅲa→Ⅲb，1例Ⅲb→Ⅳ。結論 D2-40及CK檢測在診斷淋巴管浸潤和淋巴結微轉移上優于HE檢查。CK20和CKpan的聯合檢查有利于發現微轉移淋巴結。腫瘤TNM分期越晚，越易發生淋巴結微轉移。LVI-IM、LVD及淋巴結微轉移三者都與胃癌淋巴結轉移有關。LVD值較高者近期生存率較低。

引用本文： 姜波健,吳巨鋼,俞繼衛,李小強,卞邦健,張彪,倪曉春. 胃癌淋巴管生成、淋巴管浸潤及淋巴結微轉移的臨床意義. 中國普外基礎與臨床雜志, 2008, 15(12): 903-909. doi: 復制

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16.	達明緒，伍曉汀，羅婷. 淋巴管生成因子與消化道腫瘤 [Ｊ]. 中國普外基礎與臨床雜志, 2005; 12(6)∶630.
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20.	姜波健. 胃癌外科治療的研究熱點 [Ｊ]. 國際外科學雜志, 2007; 34(3)∶167.

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2. Fukagawa T, Sasako M, Mann GB, et al. Immunohistochemically detected micrometastases of the lymph nodes in patients with gastric carcinoma [Ｊ]. Cancer, 2001; 92(4)∶753.
3. Okada Y, Fujiwara Y, Yamamoto H, et al. Genetic detection of lymph node micrometastases in patients with gastric carcinoma by multiple-marker reverse transcriptase-polymerase chain reaction assay [Ｊ]. Cancer, 2001; 92(8)∶2056.
4. Wu ZY, Zhan WH, Li JH, et al. Expression of E-cadherin in gastric carcinoma and its correlation with lymph node micrometastasis [Ｊ]. World J Gastroenterol, 2005; 11(20)∶3139.
5. Matsumoto M, Natsugoe S, Ishigami S, et al. Lymph node micrometastasis and lymphatic mapping determined by reverse transcriptase-polymerase chain reaction in pN0 gastric carcinoma [Ｊ]. Surgery, 2002; 131(6)∶630.
6. Kahn HJ, Marks A. A new monoclonal antibody, D2-40, for detection of lymphatic invasion in primary tumor [Ｊ]. Lab Invest, 2002; 82(9)∶1255.
7. Marks A, Sutherland DR, Bailey D, et al. Characterization and distribution of an oncofetal antigen (M2A antigen) expressed on testicular germ cell tumours [Ｊ]. Br J Cancer, 1999; 80(3-4)∶569.
8. 吳巨鋼, 俞繼衛, 姜波健. 胃癌淋巴管浸潤及淋巴管生成的檢測及其意義 [Ｊ]. 中國普通外科雜志, 2008; 17(3)∶280.
9. Sako A, Kitayama J, Ishikawa M, et al. Impact of immunohistochemically identified lymphatic invasion on nodal metastasis in early gastric cancer [Ｊ]. Gastric Cancer, 2006; 9(4)∶295.
10. Yonemura Y, Endou Y, Tabachi K, et al. Evaluation of lymphatic invasion in primary gastric cancer by a new monoclonal antibody, D2-40 [Ｊ]. Hum Pathol, 2006; 37(9)∶1193.
11. Kitadai Y, Kodama M, Cho S, et al. Quantitative analysis of lymphangiogenic markers for predicting metastasis of human gastric carcinoma to lymph nodes [Ｊ]. Int J Cancer, 2005; 115(3)∶388.
12. Shida A, Fujioka S, Ishibashi Y, et al. Prognostic significance of vascular endothelial growth factor D in gastric carcinoma [Ｊ]. World J Surg, 2005; 29(12)∶1600.
13. 日本胃癌研究會編. 胃癌取りあつがい規約（改訂第十二版） [M]. 東京: 金原出版株式會社, 1993∶15~45.
14. Weidner N, Semple JP, Welch WR, et al. Tumor angiogenesis and metastasis-correlation in invasive breast carcinoma [Ｊ]. N Engl J Med, 1991; 324(1)∶1.
15. Schacht V, Dadras SS, Johnson LA, et al. Up-regulation of the lymphatic marker podoplanin, a mucin-type transmembrane glycoprotein, in human squamous cell carcinomas and germ cell tumors [Ｊ]. Am J Pathol, 2005; 166(3)∶913.
16. 達明緒，伍曉汀，羅婷. 淋巴管生成因子與消化道腫瘤 [Ｊ]. 中國普外基礎與臨床雜志, 2005; 12(6)∶630.
17. Matsunami K, Nakamura T, Oguma H, et al. Detection of bone marrow micrometastasis in gastric cancer patients by immunomagnetic separation [Ｊ]. Ann Surg Oncol, 2003; 10(2)∶171.
18. Da MX, Wu XT, Guo TK, et al. Clinical significance of telomerase activity in peritoneal lavage fluid from patients with gastric cancer and its relationship with cellular proliferation [Ｊ]. World J Gastroenterol, 2007; 13(22)∶3122.
19. Paget S. The distribution of secondary growths in cancer of the breast. 1889 [Ｊ]. Cancer Metastasis Rev, 1989; 8(2)∶98.
20. 姜波健. 胃癌外科治療的研究熱點 [Ｊ]. 國際外科學雜志, 2007; 34(3)∶167.

《中國普外基礎與臨床雜志》

胃癌淋巴管生成、淋巴管浸潤及淋巴結微轉移的臨床意義

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《中國普外基礎與臨床雜志》

胃癌淋巴管生成、淋巴管浸潤及淋巴結微轉移的臨床意義

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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