CAJ | 학술논문

目的检测Ⅰ期非小细胞肺癌(NSCLC)淋巴结微转移的情况,分析影响Ⅰ期NSCLC淋巴结微转移的主要因素,了解微转移的规律.方法采用免疫组织化学SP法对91例Ⅰ期NSCLC清扫的肺门和隆突下淋巴结进行混合性细胞角蛋白(MCK)检测,检测其微转移的表达.另收集45例肺部良性病变手术切除的肺门淋巴结45枚和Ⅱ、Ⅲ期NSCLC常规病理检查阳性的肺门淋巴结45枚进行MCK(AE1/AE3)检测,分别作为阴性和阳性对照.结果 45例肺部良性病变的肺门淋巴结45枚MCK(AE1/AE3)表达均为阴性.Ⅱ、Ⅲ期NSCLC常规病理检查阳性的肺门淋巴结45枚MCK(AE1/AE3)表达均为阳性.91例Ⅰ期NSCLC取其肺门和隆突下淋巴结各91枚进行MCK(AE1/AE3)检测,45例阳性,总的微转移率为49%(45/91).其中,肺门淋巴结39枚阳性,隆突下淋巴结11枚阳性,二者均为阳性5例.Logistic单因素分析显示:肿瘤大小、分期和分化是影响淋巴结微转移的临床因素,其相对危险度OR值分别为8.444、6.946和14.566.多因素分析显示:肿瘤T分期和分化程度是影响淋巴结微转移的主要因素,其相对危险度OR值分别为14.509和7.028.结论 Ⅰ期NSCLC淋巴结中存在微转移;ⅠB期NSCLC微转移率明显高于ⅠA期;有必要对ⅠB期NSCLC进行术后化疗;肿瘤分期和分化程度是影响淋巴结微转移的主要因素;淋巴结微转移遵循肺门到纵隔的途径;腺癌存在跳跃式微转移现象.
목적 검측Ⅰ기비소세포폐암(NSCLC)림파결미전이적정황,분석영향Ⅰ기NSCLC림파결미전이적주요인소,료해미전이적규률.방법 채용면역조직화학SP법대91례Ⅰ기NSCLC청소적폐문화륭돌하림파결진행혼합성세포각단백(MCK)검측,검측기미전이적표체.령수집45례폐부량성병변수술절제적폐문림파결45매화Ⅱ、Ⅲ기NSCLC상규병리검사양성적폐문림파결45매진행MCK(AE1/AE3)검측,분별작위음성화양성대조.결과 45례폐부량성병변적폐문림파결45매MCK(AE1/AE3)표체균위음성.Ⅱ、Ⅲ기NSCLC상규병리검사양성적폐문림파결45매MCK(AE1/AE3)표체균위양성.91례Ⅰ기NSCLC취기폐문화륭돌하림파결각91매진행MCK(AE1/AE3)검측,45례양성,총적미전이솔위49%(45/91).기중,폐문림파결39매양성,륭돌하림파결11매양성,이자균위양성5례.Logistic단인소분석현시:종류대소、분기화분화시영향림파결미전이적림상인소,기상대위험도OR치분별위8.444、6.946화14.566.다인소분석현시:종류T분기화분화정도시영향림파결미전이적주요인소,기상대위험도OR치분별위14.509화7.028.결론 Ⅰ기NSCLC림파결중존재미전이;ⅠB기NSCLC미전이솔명현고우ⅠA기;유필요대ⅠB기NSCLC진행술후화료;종류분기화분화정도시영향림파결미전이적주요인소;림파결미전이준순폐문도종격적도경;선암존재도약식미전이현상.
Objective To detect the nodal occult micrometastasis in stage Ⅰ non-small-cell lung cancer(NSCLC),and further investigate the main factor of affecting the nodal occult micrometastasis and the rule of micrometastasis in stage Ⅰ NSCLC. Methods Occult micrometastatic tumor cells by in hilar and subcarinal lymph nodes(LN)were detected immunohistochemistry (SP method),which were removed from 91patients with completely resected stage Ⅰ NSCLC.The monoclonal antibody muhicytokeratin(MCK)was used as a micrometastatic marker.Another 45 hilar LN removed from benign pulmonary lesion patients and 45 hilar LN removed from Ⅱ and Ⅲ stage NSCLC were detected, respectively by conventional histopathologic examination as negative and positive control.Results Micrometastasis was detected in all lymph nodes that were removed from stageⅡand Ⅲ NSCLC.but no one was detected in lymph nodes that were removed from benign pulmonary lesion patients.There were 45 positive cases in 91 patients.The rate of micrometastasis in stage Ⅰ NSCLC was 49%(45/91).among them 39 subcarinal lymph nodes and 11 hilar lymph nodes were detected as positive,5 cases were detected as positive both in subcrinal and hilar lymph nodes.Logistic regression analysis indicated that tumor size,stage and differentiation affected micrometastasis significantly,odd ratios(OR) were 8.444,6.946 and 14.566 respectively.The multivariate analysis indicated that cell difierentiation and T stage may be the adverse factors for nodal micrometastasis,odd ratios(OR)were 7.028and 14.509 respectively.Conclusion There is nodal micrometastasis in completely resected stage Ⅰ NSCLC patients.The micrometastasis frequency of stage ⅠB is significantly higher than stage ⅠA;It is necessary for stage ⅠB NSCLC to be given chemotherapy after operation;cell differentiation and T stage may be the adverse factors for nodal micrometastasis.The method of lymph node micrometastasis is from hilum to mediastinum.The skip micrometastasis may be taken place in adenocarcinoma.