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目的探讨大肠癌前哨淋巴结(sentinel lymph node,SLN)微转移(micrometastasis,MM)的检测方法及其临床意义。方法前瞻性研究2004年9月至2005年7月在甘肃省人民医院64例行根治性手术的DukesB期大肠癌病人,对其中61例定位成功的122枚SLN应用常规HE染色联合免疫组化SP法检测其前哨淋巴结中细胞角蛋白20(CK20)及端粒酶的表达,随访满3年,记录病人的临床病理参数和生存资料,分析其相关性。结果(1)61例中6例病人9枚SLN经常规HE检测阳性。(2)免疫组化法有27.3%(15/55)病人其SLN存在CK20阳性,21.8%(12/55)的病人SLN存在端粒酶阳性表达。(3)两者联合检测微转移检出率为38.2%(21/55)。(4)DukesB期SLNMM(+)病人癌复发转移率明显高于同期SLNMM(-)组(P<0.05),存活率则降低(P<0.05),与DukesC期对比差异无统计学意义;SLNMM(-)组的复发转移率、存活率与同期DukesC期病人对比,差异有统计学意义(P<0.05)。结论免疫组化法联合检测端粒酶和CK20可提高DukesB期大肠癌SLNMM的检出率,并且对于明确大肠癌病人Dukes分期,指导术后合理的辅助治疗和预后判断有重要的临床意义。
Objective To investigate the detection of micrometastasis (MM) in sentinel lymph node (colorectal cancer) and its clinical significance. Methods A prospective study of 64 patients with DukesB colorectal cancer who underwent radical surgery in People’s Hospital of Gansu Province from September 2004 to July 2005 was performed. Totally 61 SLNs with successful localization were examined by conventional HE staining combined with immunohistochemistry SP Method to detect the expression of cytokeratin 20 (CK20) and telomerase in sentinel lymph node. The patients were followed up for 3 years. The clinicopathological parameters and survival data were recorded and the correlation was analyzed. Results (1) Of the 61 patients, 9 patients with 6 SLN were detected by routine HE test. (2) CK20 was positive in SLN in 27.3% (15/55) of patients by immunohistochemistry and telomerase was positive in SLN in 21.8% (12/55) of patients. (3) The combined detection of micrometastasis between the two was 38.2% (21/55). (4) The recurrence and metastasis rate of DukesB SLNMM patients was significantly higher than that of SLNMM patients (P <0.05), and the survival rate was lower (P <0.05), but there was no significant difference between Dukes B and Dukes C. SLNMM (-) group of recurrence and metastasis rate, survival rate and DukesC phase patients with the same period, the difference was statistically significant (P <0.05). Conclusions Immunohistochemical detection of telomerase and CK20 can improve the detection rate of SLNMM in DukesB stage colorectal cancer and has important clinical significance for clarifying Dukes staging of colorectal cancer patients and guiding the reasonable adjuvant therapy and prognosis postoperatively.