• 南京醫(yī)科大學(xué)附屬南京第一醫(yī)院普外科(江蘇南京 210 006);

目的 　使用實(shí)時(shí)熒光定量PCR(qRT-PCR)法檢測胃癌淋巴結(jié)的微轉(zhuǎn)移情況，并探討微轉(zhuǎn)移的臨床意義。
方法 　收集我院2010年1～6月期間40例行胃癌根治術(shù)切除的281枚和10例行胃十二指腸潰瘍手術(shù)切除的39枚，共計(jì)320枚淋巴結(jié)標(biāo)本，以CEA、CK-19和CK-20為引物進(jìn)行qRT-PCR檢測其微轉(zhuǎn)移情況，并分析微轉(zhuǎn)移的臨床病理特點(diǎn)。
結(jié)果 　40例胃癌患者中有28例(70.00%)、31枚(15.35%，31/202)淋巴結(jié)檢測出有微轉(zhuǎn)移。10例胃潰瘍的39枚淋巴結(jié)標(biāo)本，HE染色檢測和qRT-PCR檢測均為陰性。淋巴結(jié)微轉(zhuǎn)移的陽性率與腫瘤分化程度、浸潤深度和臨床分期有關(guān)(P＜0.05)。
結(jié)論 　qRT-PCR是檢測胃癌淋巴結(jié)微轉(zhuǎn)移敏感且特異的方法，對胃癌臨床分期、判斷預(yù)后以及治療方案選擇具有重要意義。

引用本文： 呂成余,謝洪虎,王蓓,陳維,袁愛華,殷信道. 實(shí)時(shí)熒光定量PCR 檢測胃癌淋巴結(jié)微轉(zhuǎn)移及其臨床意義. 中國普外基礎(chǔ)與臨床雜志, 2012, 19(1): 31-36. doi: 復(fù)制

1. Kodera E， Fujiwara M， Ito Y， et al. Radical surgery for gastric carcinoma：it is not an issue of whether to perform D1 or D2.Dissect as many lymph nodes as possible and you will be rewarded [J]. Acta Chir Belg， 2009， 109(1)： 27-35.
2. Coburn NG. Lymph nodes and gastric cancer [ J]. J Surg Oncol，2009， 99(4)： 199-206.
3. Yanagita S， Natsugoe S， Uenosono Y， et al. Detection of micrometastases in sentinel node navigation surgery for gastric cancer [J]. Surg Oncol， 2008， 17(3)： 203-210.
4. Aurello P， D’angelo F， Nigri G， et al. Comparison between site N-category and number N-category for nodal staging in carcinoma of the gastroesophageal junction： our experience and literature review [J]. Am Surg， 2006， 72(2)： 118-123.
5. Cai J， Ikeguchi M， Maeta M， et al. Micrometastasis in lymph nodes and microinvasion of the muscularis propria in primary lesions of submucosal gastric cancer [J]. urgery， 2000， 127(1)：32-39.
6. Kim DY， Joo JK， Ryu SY， et al. Factors related to lymph node metastasis and surgical strategy used to treat early gastric carcinoma[J]. World J Gastroenterol， 2004， 10(5)： 737-740.
7. Folli S， Morgagni P， Roviello F， et al. Risk factors for lymph node metastases and their prognostic significance in early gastric cancer (EGC) for the Italian Research Group for Gastric Cancer (IRGGC) [J]. Jpn J Clin Oncol， 2001， 31(10)： 495-499.
8. 何清， 焦?jié)嵢悖?魏旭倩， 等. 胃癌患者外周血癌胚抗原、細(xì)胞角蛋白20 及生存素基因檢測的臨床意義 [J]. 診斷學(xué)理論與實(shí)踐， 2010， 9(1)： 74-78．.
9. Fujita Y， Terashima M， Hoshino Y， et al. Detection of cancer cells disseminated in bone marrow using real-time quantitative RT-PCR of CEA， CK19， and CK20 mRNA in patients with gastric cancer [J]. Gastric Cancer， 2006， 9(4)： 308-314.
10. Livak KJ， Schmittgen TD. Analysis of relative gene expression data using real-time quantitative PCR and the 2〔-Delta Delta C (T)〕Method [J]. Methods， 2001， 25(4)： 402-408.
11. Huvos AG， Hutter RV， Berg JW. Significance of axillary macrometastases and micrometastases in mammary cancer [J]. Ann Surg， 1971， 173(1)： 44-46.
12. Nasser IA， Lee AK， Bosari S， et al. Occult axillary lymph node metastases in“ node-negative” breast carcinoma [J]. Hum Pathol， 1993， 24(9)： 950-957.
13. Kubota K， Nakanishi H， Hiki N， et al. Quantitative detection of micrometastases in the lymph nodes of gastric cancer patients with real-time RT-PCR： a comparative study with immunohistochemistry [J]. Int J Cancer， 2003， 105(1)： 136-143.
14. Miyake Y， Fujiwara Y， Ohue M， et al. Quantification of micrometastases in lymph nodes of colorectal cancer using real-time fluorescence polymerase chain reaction [J]. Int J Oncol， 2000，16(2)： 289-293.
15. Nakanishi H， Kodera Y， Yamamura Y， et al. Rapid quantitative detection of carcinoembryonic antigen-expressing free tumor cells in the peritoneal cavity of gastric-cancer atients with real-time RT-PCR on the lightcycler [J]. Int J Cancer， 2000， 89(5)： 411-417.
16. Kodera Y， Nakanishi H， Ito S， et al. Quantitative detection of disseminated free cancer cells in peritoneal washes with realtime reverse transcriptase-polymerase chain reaction： a sensitive predictor of outcome for patients with gastric carcinoma [J]. Ann Surg， 2002， 235(4)： 499-506.
17. Arigami T， Natsugoe S， Uenosono Y， et al. Evaluation of sentinel node concept in gastric cancer based on lymph node micrometastasis determined by reverse transcription-polymerase chain reaction [J]. Ann Surg， 2006， 243(3)： 341-347.
18. Matsumoto M， Natsugoe S， Ishigami S， et al. Lymph node micrometastasis and lymphatic mapping determined by reverse transcriptase-polymerase chain reaction in pN0 gastric carcinoma [J]. Surgery， 2002， 131(6)： 630-635.
19. Okada Y， Fujiwara Y， Yamamoto H， et al. Genetic detection of lymph node micrometastases in patients with gastric carcinoma by multiple-marker reverse transcriptase-polymerase chain reaction assay [J]. Cancer， 2001， 92(8)： 2056-2064.
20. Osaka H， Yashiro M， Sawada T， et al. Is a lymph node detected by the dye-guided method a true sentinel node in gastric cancer? [J]. Clin Cancer Res， 2004， 10(20)： 6912-6918.
21. Higashi H， Natsugoe S， Ishigami S， et al. Distribution of lymph node metastasis including micrometastasis in gastric cancer with submucosal invasion [J]. World J Surg， 2003， 27(4)： 455-459.
22. Arigami T， Natsugoe S， Uenosono Y， et al. Lymphatic invasion using D2-40 monoclonal antibody and its relationship to lymph node micrometastasis in pN0 gastric cancer [J]. Br J Cancer，2005， 93(6)： 688-693.
23. Tajima Y， Murakami M， Yamazaki K， et al. Risk factors for lymph node metastasis from gastric cancers with submucosal invasion [J]. Ann Surg Oncol， 2010， 17(6)： 1597-1604.
24. Miyake K， Seshimo A， Kameoka S. Assessment of lymph node micrometastasis in early gastric cancer in relation to sentinel nodes [J]. Gastric Cancer， 2006， 9(3)： 197-202.
25. Kim JJ， Song KY， Hur H， et al. Lymph node micrometastasis in node negative early gastric cancer [J]. Eur J Surg Oncol， 2009， 35(4)： 409-414.
26. Morgagni P， Saragoni L， Scarpi E， et al. Lymph node micrometastases in early gastric cancer and their impact on prognosis [J].World J Surg， 2003， 27(5)： 558-561.
27. Harrison LE， Choe JK， Goldstein M， et al. Prognostic significance of immunohistochemical micrometastases in node negative gastric cancer patients [J] . J Surg Oncol， 2000， 73(3)： 153-157.
28. Lee E， Chae Y， Kim I， et al. Prognostic relevance of immunohisto chemically detected lymph node micrometastasis in patients with gastric carcinoma [J]. Cancer， 2002， 94(11)： 2867-2873.中國普外基礎(chǔ)與臨床雜志2012 年1 月第19 卷第1 期 Chin J Bases ? 36 ? Clin General Surg, Vol. 19, No. 1, Jan. 2012.
29. Yonemura Y， Endo Y， Hayashi I， et al. Proliferative activity of micrometastases in the lymph nodes of patients with gastric cancer [J]. Br J Surg， 2007， 94(6)： 731-736.
30. Yanagita S， Natsugoe S， Uenosono Y， et al. Sentinel node micrometastases have high proliferative potential in gastric cancer [J]. J Surg Res， 2008， 145(2)： 238-243.
31. Choi HJ， Kim YK， Kim YH， et al. Occurrence and prognostic implications of micrometastases in lymph nodes from patients with submucosal gastric carcinoma [J]. Ann Surg Oncol， 2002， 9(1)：13-19.
32. Baba H， Maehara Y， Takeuchi H， et al. Effect of lymph node dissection on the prognosis in patients with node-negative early gastric cancer [J]. Surgery， 1995， 117(2)： 165-169.
  1. 1. Kodera E， Fujiwara M， Ito Y， et al. Radical surgery for gastric carcinoma：it is not an issue of whether to perform D1 or D2.Dissect as many lymph nodes as possible and you will be rewarded [J]. Acta Chir Belg， 2009， 109(1)： 27-35.
  2. 2. Coburn NG. Lymph nodes and gastric cancer [ J]. J Surg Oncol，2009， 99(4)： 199-206.
  3. 3. Yanagita S， Natsugoe S， Uenosono Y， et al. Detection of micrometastases in sentinel node navigation surgery for gastric cancer [J]. Surg Oncol， 2008， 17(3)： 203-210.
  4. 4. Aurello P， D’angelo F， Nigri G， et al. Comparison between site N-category and number N-category for nodal staging in carcinoma of the gastroesophageal junction： our experience and literature review [J]. Am Surg， 2006， 72(2)： 118-123.
  5. 5. Cai J， Ikeguchi M， Maeta M， et al. Micrometastasis in lymph nodes and microinvasion of the muscularis propria in primary lesions of submucosal gastric cancer [J]. urgery， 2000， 127(1)：32-39.
  6. 6. Kim DY， Joo JK， Ryu SY， et al. Factors related to lymph node metastasis and surgical strategy used to treat early gastric carcinoma[J]. World J Gastroenterol， 2004， 10(5)： 737-740.
  7. 7. Folli S， Morgagni P， Roviello F， et al. Risk factors for lymph node metastases and their prognostic significance in early gastric cancer (EGC) for the Italian Research Group for Gastric Cancer (IRGGC) [J]. Jpn J Clin Oncol， 2001， 31(10)： 495-499.
  8. 8. 何清， 焦?jié)嵢悖?魏旭倩， 等. 胃癌患者外周血癌胚抗原、細(xì)胞角蛋白20 及生存素基因檢測的臨床意義 [J]. 診斷學(xué)理論與實(shí)踐， 2010， 9(1)： 74-78．.
  9. 9. Fujita Y， Terashima M， Hoshino Y， et al. Detection of cancer cells disseminated in bone marrow using real-time quantitative RT-PCR of CEA， CK19， and CK20 mRNA in patients with gastric cancer [J]. Gastric Cancer， 2006， 9(4)： 308-314.
  10. 10. Livak KJ， Schmittgen TD. Analysis of relative gene expression data using real-time quantitative PCR and the 2〔-Delta Delta C (T)〕Method [J]. Methods， 2001， 25(4)： 402-408.
  11. 11. Huvos AG， Hutter RV， Berg JW. Significance of axillary macrometastases and micrometastases in mammary cancer [J]. Ann Surg， 1971， 173(1)： 44-46.
  12. 12. Nasser IA， Lee AK， Bosari S， et al. Occult axillary lymph node metastases in“ node-negative” breast carcinoma [J]. Hum Pathol， 1993， 24(9)： 950-957.
  13. 13. Kubota K， Nakanishi H， Hiki N， et al. Quantitative detection of micrometastases in the lymph nodes of gastric cancer patients with real-time RT-PCR： a comparative study with immunohistochemistry [J]. Int J Cancer， 2003， 105(1)： 136-143.
  14. 14. Miyake Y， Fujiwara Y， Ohue M， et al. Quantification of micrometastases in lymph nodes of colorectal cancer using real-time fluorescence polymerase chain reaction [J]. Int J Oncol， 2000，16(2)： 289-293.
  15. 15. Nakanishi H， Kodera Y， Yamamura Y， et al. Rapid quantitative detection of carcinoembryonic antigen-expressing free tumor cells in the peritoneal cavity of gastric-cancer atients with real-time RT-PCR on the lightcycler [J]. Int J Cancer， 2000， 89(5)： 411-417.
  16. 16. Kodera Y， Nakanishi H， Ito S， et al. Quantitative detection of disseminated free cancer cells in peritoneal washes with realtime reverse transcriptase-polymerase chain reaction： a sensitive predictor of outcome for patients with gastric carcinoma [J]. Ann Surg， 2002， 235(4)： 499-506.
  17. 17. Arigami T， Natsugoe S， Uenosono Y， et al. Evaluation of sentinel node concept in gastric cancer based on lymph node micrometastasis determined by reverse transcription-polymerase chain reaction [J]. Ann Surg， 2006， 243(3)： 341-347.
  18. 18. Matsumoto M， Natsugoe S， Ishigami S， et al. Lymph node micrometastasis and lymphatic mapping determined by reverse transcriptase-polymerase chain reaction in pN0 gastric carcinoma [J]. Surgery， 2002， 131(6)： 630-635.
  19. 19. Okada Y， Fujiwara Y， Yamamoto H， et al. Genetic detection of lymph node micrometastases in patients with gastric carcinoma by multiple-marker reverse transcriptase-polymerase chain reaction assay [J]. Cancer， 2001， 92(8)： 2056-2064.
  20. 20. Osaka H， Yashiro M， Sawada T， et al. Is a lymph node detected by the dye-guided method a true sentinel node in gastric cancer? [J]. Clin Cancer Res， 2004， 10(20)： 6912-6918.
  21. 21. Higashi H， Natsugoe S， Ishigami S， et al. Distribution of lymph node metastasis including micrometastasis in gastric cancer with submucosal invasion [J]. World J Surg， 2003， 27(4)： 455-459.
  22. 22. Arigami T， Natsugoe S， Uenosono Y， et al. Lymphatic invasion using D2-40 monoclonal antibody and its relationship to lymph node micrometastasis in pN0 gastric cancer [J]. Br J Cancer，2005， 93(6)： 688-693.
  23. 23. Tajima Y， Murakami M， Yamazaki K， et al. Risk factors for lymph node metastasis from gastric cancers with submucosal invasion [J]. Ann Surg Oncol， 2010， 17(6)： 1597-1604.
  24. 24. Miyake K， Seshimo A， Kameoka S. Assessment of lymph node micrometastasis in early gastric cancer in relation to sentinel nodes [J]. Gastric Cancer， 2006， 9(3)： 197-202.
  25. 25. Kim JJ， Song KY， Hur H， et al. Lymph node micrometastasis in node negative early gastric cancer [J]. Eur J Surg Oncol， 2009， 35(4)： 409-414.
  26. 26. Morgagni P， Saragoni L， Scarpi E， et al. Lymph node micrometastases in early gastric cancer and their impact on prognosis [J].World J Surg， 2003， 27(5)： 558-561.
  27. 27. Harrison LE， Choe JK， Goldstein M， et al. Prognostic significance of immunohistochemical micrometastases in node negative gastric cancer patients [J] . J Surg Oncol， 2000， 73(3)： 153-157.
  28. 28. Lee E， Chae Y， Kim I， et al. Prognostic relevance of immunohisto chemically detected lymph node micrometastasis in patients with gastric carcinoma [J]. Cancer， 2002， 94(11)： 2867-2873.中國普外基礎(chǔ)與臨床雜志2012 年1 月第19 卷第1 期 Chin J Bases ? 36 ? Clin General Surg, Vol. 19, No. 1, Jan. 2012.
  29. 29. Yonemura Y， Endo Y， Hayashi I， et al. Proliferative activity of micrometastases in the lymph nodes of patients with gastric cancer [J]. Br J Surg， 2007， 94(6)： 731-736.
  30. 30. Yanagita S， Natsugoe S， Uenosono Y， et al. Sentinel node micrometastases have high proliferative potential in gastric cancer [J]. J Surg Res， 2008， 145(2)： 238-243.
  31. 31. Choi HJ， Kim YK， Kim YH， et al. Occurrence and prognostic implications of micrometastases in lymph nodes from patients with submucosal gastric carcinoma [J]. Ann Surg Oncol， 2002， 9(1)：13-19.
  32. 32. Baba H， Maehara Y， Takeuchi H， et al. Effect of lymph node dissection on the prognosis in patients with node-negative early gastric cancer [J]. Surgery， 1995， 117(2)： 165-169.