CAJ | 학술논문

目的观察CK19和CK20在肝外胆管癌(EHCC)淋巴结微转移中的表达,探讨淋巴结微转移与临床病理特征和CA19-9、癌胚抗原(CEA)的关系,以及淋巴结微转移对预后的影响.方法选取59例行手术切除EHCC患者的279枚淋巴结,分别以CK19、CK20单克隆抗体进行免疫组化染色和常规HE染色,确定有无淋巴结转移与微转移,并与各病例的临床病理及随访资料进行比较,分析微转移与临床病理因素的关系及对生存率的影响.结果 59例患者的淋巴结转移率,HE诊断仅23.72%(14/59),而CK诊断为35.59%(21/59,P<0.05);淋巴结转移发生率由HE染色的5.37%提高到CK染色的13.98%(P<0.05);在常规HE染色诊断没有淋巴结转移的45例患者中,微转移的发生率为15.56%(7/45).淋巴结微转移术前血清CA19-9浓度显著高于无淋巴结微转移者(对照组)(P<0.05);淋巴结微转移与血清CA19-9浓度呈正相关(r_s=0.371,P<0.05).对12个因素进行Logistic回归分析,结果显示肿瘤的组织学类型和淋巴浸润对淋巴结微转移有重要影响(P<0.05).结论 CK免疫组化染色能检测出HE染色阴性淋巴结中隐匿的癌细胞,淋巴结微转移能够更准确地判断EHCC患者的预后.
목적 관찰CK19화CK20재간외담관암(EHCC)림파결미전이중적표체,탐토림파결미전이여림상병리특정화CA19-9、암배항원(CEA)적관계,이급림파결미전이대예후적영향.방법 선취59례행수술절제EHCC환자적279매림파결,분별이CK19、CK20단극륭항체진행면역조화염색화상규HE염색,학정유무림파결전이여미전이,병여각병례적림상병리급수방자료진행비교,분석미전이여림상병리인소적관계급대생존솔적영향.결과 59례환자적림파결전이솔,HE진단부23.72%(14/59),이CK진단위35.59%(21/59,P<0.05);림파결전이발생솔유HE염색적5.37%제고도CK염색적13.98%(P<0.05);재상규HE염색진단몰유림파결전이적45례환자중,미전이적발생솔위15.56%(7/45).림파결미전이술전혈청CA19-9농도현저고우무림파결미전이자(대조조)(P<0.05);림파결미전이여혈청CA19-9농도정정상관(r_s=0.371,P<0.05).대12개인소진행Logistic회귀분석,결과현시종류적조직학류형화림파침윤대림파결미전이유중요영향(P<0.05).결론 CK면역조화염색능검측출HE염색음성림파결중은닉적암세포,림파결미전이능구경준학지판단EHCC환자적예후.
Objective To observe the expression of antibodies of cytokeratin 19 and 20 in lymph node micrometastasis in patients with extrahepatic cholangiocarcinoma(EHCC),evaluate the prognostic significance of lymph node (LN) mierometastasis and study the correlation between lymph node micrometastasis and clinicopathological features,CA19-9 and CEA.Methods A total of 279 lymph nodes was intra-operatively collected from 59 EHCC patients and routine histological examination performed. Immunohistochemical staining was performed on all samples by the murine antibodies of anti-CK19 and anti-CK20 respectively.Then the micrometastasis was identified microscopically according to the color of cells.The results were analyzed according to clinical,pathological and follow-up data.And the relation of micrometastasis with clinical pathological factors and its impact upon survival rate were analyzed.Results Among 59 EHCC patients,14(23.72%)LN metastasis were found with HE staining and 21 micrometastases with CK staining.The incidence of nodal involvement in 59 EHCC patients increased from 5.37%(15/279)by HE staining to 13.98%(39/279)by CK staining.Among 45 patients not positive for LN metastases with HE staining, CK staining was positive in 7 patients and the incidence of micrometastasis was 15.56%.The preoperative serum CA19-9 levels in patients with LN micrometastasis was higher than that those without LN metastasis(P<0.05).And there was a positive correlation between occult nodal micrometastasis and serum concentrations of CA19-9(r_s=0.371,P<0.05).The histological type and lymphatic vessel infihration of tumor were the most importance factors for LN micrometastasis through Logistic regression analysis(P<0.05).Conclusion The CK immunohistochemical staining can detect the micrometastases in HE negative LN.And LN micrometastasis can more accurately predict the prognosis of EHCC patients.