CAJ | 학술논문

目的探讨Ⅱ期直肠癌患者淋巴结微转移检测的临床意义.方法对2000年1月至2001年8月行全直肠系膜切除术的42例Ⅱ期直肠癌标本的484枚淋巴结行间断病理切片结合细胞角蛋白20(CK20)免疫组化染色检测,根据随访资料结合文献分析Ⅱ期直肠癌患者系膜淋巴结微转移的临床意义.结果 42例患者中淋巴结微转移发生总例数为15例,发生率为35.7%(15/42),淋巴结微转移检出总数为33枚,检出率为6.8%(33/484).随访12～80个月,以60个月为界,31例存活,11例死亡.淋巴结微转移阳性患者5年生存率为40.0%,淋巴结微转移阴性患者5年生存率为92.6%.经Log-rank检验两者的生存率比较差异有统计学意义(P=0.000).Cox比例风险回归模型分析示淋巴结微转移的RR值为11.435,是惟一引入的危险因素.结论淋巴结微转移是Ⅱ期直肠癌患者重要的预后指标,淋巴结微转移是直肠癌患者术后复发转移的独立预后指标,有淋巴结微转移的直肠癌术后患者可能从化疗中受益.
목적 탐토Ⅱ기직장암환자림파결미전이검측적림상의의.방법 대2000년1월지2001년8월행전직장계막절제술적42례Ⅱ기직장암표본적484매림파결행간단병리절편결합세포각단백20(CK20)면역조화염색검측,근거수방자료결합문헌분석Ⅱ기직장암환자계막림파결미전이적림상의의.결과 42례환자중림파결미전이발생총례수위15례,발생솔위35.7%(15/42),림파결미전이검출총수위33매,검출솔위6.8%(33/484).수방12～80개월,이60개월위계,31례존활,11례사망.림파결미전이양성환자5년생존솔위40.0%,림파결미전이음성환자5년생존솔위92.6%.경Log-rank검험량자적생존솔비교차이유통계학의의(P=0.000).Cox비례풍험회귀모형분석시림파결미전이적RR치위11.435,시유일인입적위험인소.결론 림파결미전이시Ⅱ기직장암환자중요적예후지표,림파결미전이시직장암환자술후복발전이적독립예후지표,유림파결미전이적직장암술후환자가능종화료중수익.
Objective To explore the clinical significance of lymph node micrometastases in stage Ⅱ rectal cancer patients. Methods Forty-two patients with rectal cancer underwent total mesorectal exci-sion between January 2000 and August 2001 were included, 484 lymph nodes were studied in paraffin blocks that had previously been considered free by conventional histopathological examination. These lymph nodes were submitted to immunohistochemical analysis using cytokeratin 20 (CK20) monoclonal antibodies to identify micrometastases. Five-year follow-up information was obtained on these patients. Observed survival rates and assessed respectively in the patients with and without micrometastases. Results Micrometastases were detected in 33 lymph nodes (6.8% ,33/484) of 15 cases (35.7%, 15/42). The five-year survival rate was 40.0% in the patients with micrometastases, whereas in the patients without micrometastases, the survival rate was 92.6%(P = 0.000,by the Log-rank test). By multivariate Cox regression analysis, lymph node mi-cromctastases was closely correlated with post-operative recurrence or metastases, the value of RR was 11.435. Conclusions Detection of micrometastases is an important prognostic tool in stage Ⅱ rectal can-cer. In this study, lymph nodes micrometastases is an independent prognostic factor for overall survival. These patients maybe get benefit from adjuvant chemotherapy.