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目的:探讨胃癌淋巴结微转移及临床病理因素对p T1-4aN1-3M0期胃癌患者术后5年无瘤生存率的影响。方法:选取我院2009年1月至12月期间胃肠外科单一手术组行D2胃癌根治术p T1-4aN1-3M0期患者63例1427枚HE染色阴性淋巴结,应用免疫组化法检测这些淋巴结中CK19表达,观察微转移的情况并分析发生微转移的胃癌患者临床病理特征及对患者5年无瘤生存率的影响。结果:临床病理分期p T1-4aN1-3M0胃癌患者中,经免疫组化染色,1427枚HE常规染色阴性淋巴结中CK19阳性表达率为15.49%(221/1427);63例胃癌患者中CK19表达阳性率39.68%(25/63);术后随访时间5.6~68.5月(平均时间43.88月),淋巴结中CK19阴性表达、阳性表达患者的总5年生存率分别为52.63%、28.00%;两者无瘤生存率差异有统计学意义(x2=8.677,P=0.003)。淋巴结CK19阳性表达与胃癌患者的肿瘤直径(P<0.05)、浸润胃壁深度(P<0.05)有关。COX生存回归分析显示淋巴结微转移为独立预后因素。25例患者发现淋巴结微转移并推荐再分期,再分期率39.68%(25/63)。结论:p T1-4aN1-3M0期胃癌病人,CK-19免疫组化法染色能检出常规HE染色阴性淋巴结中的微转移,有助于细化分期、判断预后及指导治疗。
Objective: To investigate the effect of lymph node micrometastasis and clinicopathological factors on the 5-year disease-free survival rate of patients with gastric cancer with p T1-4aN1-3M0 stage. Methods: A total of 1427 HE-negative negative lymph nodes were obtained from 63 patients with gastric cancer undergoing D2 gastric cancer radical resection from January 2009 to December 2009 in our department. The immunohistochemical methods CK19 expression was observed, the situation of micrometastasis was observed and the clinicopathological features of patients with micrometastasis and the 5-year tumor-free survival rate were analyzed. Results: The positive rate of CK19 in 1427 HE staining cells was 15.49% (221/1427) in immunohistochemical staining of pT1-4aN1-3M0 gastric cancer. The positive expression of CK19 in 63 gastric cancer patients (39.68%, 25/63). The follow-up time ranged from 5.6 to 68.5 months (mean time, 43.88 months). The overall 5-year survival rate of CK19 negative expression in lymph nodes was 52.63% and 28.00% The difference of tumor survival rate was statistically significant (x2 = 8.677, P = 0.003). The positive expression of CK19 in lymph nodes correlated with tumor diameter (P <0.05) and infiltration depth (P <0.05) in gastric cancer patients. COX survival regression analysis showed that lymph node micrometastasis was an independent prognostic factor. Twenty-five patients were found to have micrometastasis of lymph nodes and recommended for re-staging, with a re-staging rate of 39.68% (25/63). CONCLUSIONS: In the patients with gastric cancer of pT1-4aN1-3M0 stage, CK-19 immunohistochemical staining can detect micrometastasis in conventional HE-negative lymph nodes, which can help to refine the stage, judge the prognosis and guide the treatment.