目的  探討胃癌淋巴管生成、淋巴管浸潤(rùn)及淋巴結(jié)微轉(zhuǎn)移的臨床意義。方法  免疫組化法檢測(cè)68例胃癌原發(fā)灶中D2-40的表達(dá)及其中 51例胃癌的791枚淋巴結(jié)中CK20和CKpan的表達(dá)，結(jié)合患者的臨床病理特征進(jìn)行綜合分析。結(jié)果  胃癌HE染色淋巴管浸潤(rùn)（LVI-HE）和D2-40染色淋巴管浸潤(rùn)（LVI-IM）的陽(yáng)性率分別為66.2%（45/68）和76.5%（52/68），差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.118)。LVI-IM陽(yáng)性率與腫瘤浸潤(rùn)深度（P=0.044）、TNM分期（P=0.003）及存在淋巴結(jié)轉(zhuǎn)移(P=0.000)有關(guān)。68例胃癌平均淋巴管密度（LVD）為（18.19±7.44）個(gè)/HP。 LVD升高與LVI-HE陽(yáng)性（P=0.040）、LVI-IM陽(yáng)性（P=0.001）、靜脈浸潤(rùn)（P=0.037）、TNM分期較晚（P=0.020）及存在淋巴結(jié)轉(zhuǎn)移（P=0.001）有關(guān)系。LVD值≥15個(gè)/HP者近期生存率較LVD值≤14個(gè)/HP者明顯降低（P=0.032）。51例胃癌HE染色和CK（CK20或CKpan）染色檢出淋巴結(jié)轉(zhuǎn)移率分別為74.5%（38/51）和88.2%（45/51），791枚淋巴結(jié)的轉(zhuǎn)移淋巴結(jié)檢出率由HE染色的32.0%（253/791）提高到CK染色的41.5%（328/791），P＜0.001。CKpan的微轉(zhuǎn)移檢出率明顯高于CK20（P=0.003）。微轉(zhuǎn)移淋巴結(jié)數(shù)量與腫瘤大?。≒=0.001）、LVI-HE（P=0.040）、腫瘤浸潤(rùn)深度（P=0.018）及TNM分期（P=0.012）有關(guān)。微轉(zhuǎn)移淋巴結(jié)的檢出使淋巴結(jié)轉(zhuǎn)移站別及TNM分期遷移： 7例N0→N1，6例N1→N2，1例N2→N3； 4例Ⅰb→Ⅱ，4例Ⅱ→Ⅲa，3例Ⅲa→Ⅲb，1例Ⅲb→Ⅳ。結(jié)論  D2-40及CK檢測(cè)在診斷淋巴管浸潤(rùn)和淋巴結(jié)微轉(zhuǎn)移上優(yōu)于HE檢查。CK20和CKpan的聯(lián)合檢查有利于發(fā)現(xiàn)微轉(zhuǎn)移淋巴結(jié)。腫瘤TNM分期越晚，越易發(fā)生淋巴結(jié)微轉(zhuǎn)移。LVI-IM、LVD及淋巴結(jié)微轉(zhuǎn)移三者都與胃癌淋巴結(jié)轉(zhuǎn)移有關(guān)。LVD值較高者近期生存率較低。

引用本文： 姜波健,吳巨鋼,俞繼衛(wèi),李小強(qiáng),卞邦健,張彪,倪曉春. 胃癌淋巴管生成、淋巴管浸潤(rùn)及淋巴結(jié)微轉(zhuǎn)移的臨床意義. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008, 15(12): 903-909. doi: 復(fù)制

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20. 姜波健. 胃癌外科治療的研究熱點(diǎn) [Ｊ]. 國(guó)際外科學(xué)雜志, 2007; 34(3)∶167.
  1. 1. Hayashi N, Ito I, Yanagisawa A, et al. Genetic diagnosis of lymph-node metastasis in colorectal cancer [Ｊ]. Lancet, 1995; 345(8960)∶1257.
  2. 2. Fukagawa T, Sasako M, Mann GB, et al. Immunohistochemically detected micrometastases of the lymph nodes in patients with gastric carcinoma [Ｊ]. Cancer, 2001; 92(4)∶753.
  3. 3. 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.
  4. 4. Wu ZY, Zhan WH, Li JH, et al. Expression of E-cadherin in gastric carcinoma and its correlation with lymph node micrometastasis [Ｊ]. World J Gastroenterol, 2005; 11(20)∶3139.
  5. 5. 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.
  6. 6. Kahn HJ, Marks A. A new monoclonal antibody, D2-40, for detection of lymphatic invasion in primary tumor [Ｊ]. Lab Invest, 2002; 82(9)∶1255.
  7. 7. Marks A, Sutherland DR, Bailey D, et al. Characterization and distribution of an oncofetal antigen (M2A antigen) expressed on testicular germ cell tumours [Ｊ]. Br J Cancer, 1999; 80(3-4)∶569.
  8. 8. 吳巨鋼, 俞繼衛(wèi), 姜波健. 胃癌淋巴管浸潤(rùn)及淋巴管生成的檢測(cè)及其意義 [Ｊ]. 中國(guó)普通外科雜志, 2008; 17(3)∶280.
  9. 9. Sako A, Kitayama J, Ishikawa M, et al. Impact of immunohistochemically identified lymphatic invasion on nodal metastasis in early gastric cancer [Ｊ]. Gastric Cancer, 2006; 9(4)∶295.
  10. 10. Yonemura Y, Endou Y, Tabachi K, et al. Evaluation of lymphatic invasion in primary gastric cancer by a new monoclonal antibody, D2-40 [Ｊ]. Hum Pathol, 2006; 37(9)∶1193.
  11. 11. Kitadai Y, Kodama M, Cho S, et al. Quantitative analysis of lymphangiogenic markers for predicting metastasis of human gastric carcinoma to lymph nodes [Ｊ]. Int J Cancer, 2005; 115(3)∶388.
  12. 12. Shida A, Fujioka S, Ishibashi Y, et al. Prognostic significance of vascular endothelial growth factor D in gastric carcinoma [Ｊ]. World J Surg, 2005; 29(12)∶1600.
  13. 13. 日本胃癌研究會(huì)編. 胃癌取りあつがい規(guī)約（改訂第十二版） [M]. 東京: 金原出版株式會(huì)社, 1993∶15~45.
  14. 14. Weidner N, Semple JP, Welch WR, et al. Tumor angiogenesis and metastasis-correlation in invasive breast carcinoma [Ｊ]. N Engl J Med, 1991; 324(1)∶1.
  15. 15. Schacht V, Dadras SS, Johnson LA, et al. Up-regulation of the lymphatic marker podoplanin, a mucin-type transmembrane glycoprotein, in human squamous cell carcinomas and germ cell tumors [Ｊ]. Am J Pathol, 2005; 166(3)∶913.
  16. 16. 達(dá)明緒， 伍曉汀， 羅 婷. 淋巴管生成因子與消化道腫瘤 [Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2005; 12(6)∶630.
  17. 17. Matsunami K, Nakamura T, Oguma H, et al. Detection of bone marrow micrometastasis in gastric cancer patients by immunomagnetic separation [Ｊ]. Ann Surg Oncol, 2003; 10(2)∶171.
  18. 18. Da MX, Wu XT, Guo TK, et al. Clinical significance of telomerase activity in peritoneal lavage fluid from patients with gastric cancer and its relationship with cellular proliferation [Ｊ]. World J Gastroenterol, 2007; 13(22)∶3122.
  19. 19. Paget S. The distribution of secondary growths in cancer of the breast. 1889 [Ｊ]. Cancer Metastasis Rev, 1989; 8(2)∶98.
  20. 20. 姜波健. 胃癌外科治療的研究熱點(diǎn) [Ｊ]. 國(guó)際外科學(xué)雜志, 2007; 34(3)∶167.