中国实用外科杂志

中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (03): 239-242.

• 论著 • 上一篇    下一篇

细胞角蛋白20及端粒酶的表达在大肠癌微转移中的意义

王 涛1，杨熊飞2a，张维胜2a,张艾莉2a,郭天康2b   

  1. 1 兰州大学，甘肃兰州 730000；2 甘肃省人民医院a.肛肠科，b.普外科，甘肃兰州 730000
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-03-13 发布日期:2009-03-13

  • Received:1900-01-01 Revised:1900-01-01 Online:2009-03-13 Published:2009-03-13

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摘要：

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SLN MM(+)病人癌复发转移率明显高于同期SLN MM(-)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。

关键词: 大肠癌, 细胞角蛋白20, 端粒酶, 癌细胞微转移

Abstract:

Expression of CK20 and telomerase in colorectal carcinoma micrometastasis and its significance WANG Tao*, YANG Xiong Fei, ZHANG Wei-sheng , et al. *Lanzhou University, Lanzhou 730000 ，China Corresponding author:Wang Tao ,E-mail：wangtaolanda@yahoo.com.cn Abstract Objective To investigate the detection of sentinel lymph node micrometastasis(SLNMM) and its clinical significance in these patients. Methods In a prospective study,122 SLNs were searched and examined successfully in 61 among 64 cases of DukesB colorectal carcinoma,using the immunohistochemical(IHC) staining to detect cytokeratin20(CK20) and telomerase in proper order,while the SLNs were negative by routine hematoxylin and eosin(HE) staining.Following up at least 3 years,memorized these patients’ clinical pathological parameters and survival numerical data, and analysis the dependablity. Results 9 SLNs of 6 cases were postive by HE staining;27.3%(15/55) in cases,which were negative by HE staining, were CK20 postive expression by IHC; Micrometastasis was also detected in12cases(21.8%,12/55) byIHC anti-telomerase staining.Combining the two methods can improve the micrometastasis rate as 38.2%(21/55) (P<0.05);The percent of carcinoma recurrence or metastasis for the DukesB patients with SLNMM(+) was significantly higher than that for the patients with SLNMM(-)(P<0.05),but the survival percent for the patients with SLNMM(+) was significantly lower than that for the patients with SLNMM(-).However,compared with 45 DukesC patients,the percents were no significant difference.In contrary,the percents of recurrence or metastasis and survival between DukesC patients and SLNMM(-)DukesB patients were significantly different(P<0.05).Conclusion Combining examination of immunohistochemical anti-CK20 and anti-telometase staining can improve the detection rate of SLNMM in DukesB colonrectal carcinoma patients, and it is of important clinical significance for staging Dukes, selection of adjuvant treatment and evaluation of prognosis in patients with colcrectal carcinoma.

Key words: colorectal carcinoma, cytokeratin20(CK20), telomerase, cancer cell micrometastasis