| Objective:The gastric cancer is one of our country most common malignant tumors of the alimentary canal.Also it is the malignant tumor with the highest mortality rate of all the cancers in cities.Its so high mortality rate is mainly because of the high probability of its metastasis and relapse.The metastasis and relapse of the malignant tumor are important factors that affect the tumor patient prognosis.The main way of the metastasis of the gastric cancer is through the lymph node shift,and the micrometastasis of the gastric cancer lymph node is probably the main reason to cause lymph node shift.Lymph node metastasis is one of the most important factors affecting prognosis in patients with gastric cancer and the appropriate extent of lymph node dissection has been discussed in the literature.Some authors have reported that extended lymph node dissection contributes to improving the prognosis of node-negative patients,a finding which suggests the presence of occult lymph node metastasis that is not detectable by routine histopathologic examnation.Although the paraaortic lymph nodes are distant from the stomach,patients with advanced gastric carcinoma with paraaortic lymph node metastasis have been documented. However,no unanimity currently exists in regard to the indications for and therapeutic effects of paraaortic lymphadenectomy.The biology behavior of the gastric cancer is referred to a series of indexes,which indicate the nature of the gastric cancer nature or its malignant degree.Therefore to make clear the relationship between the micrometastasis of the gastric cancer lymph node and its biological behavior is crucial to the clinical stage appraisal and the formulation of the therapeutic regimen for the gastric cancer patient.To evaluate the relationship between the micrometastasis of No.16 lymph node and the biological behavior and prognosis of 62 gastric cancer.To assess the significance of No.16 lymph node dissection in treating patient with gastric cancer.Methods:62 patient(41 men and 21 women)with gastric carcinoma were enrolled in this study between 1997 and 2008. They underwent gastrectomy with extended lymphadenectomy,including the paraaortic lymph nodes,at the First Affiliated Hospital of Dalian Medical University. None of the patients received radiation therapy or chemotherapy before surgical treatment and all were followed-up after discharge for a median follow-up period of 24 months (range,4-100 months).All specimens were formalin-fixed and paraffin-embedded.Each lymph node was stained immunohistochemcally, using AE1/AE3. Statistical analysis was performed by the chi-square test for group differences. Survival data were analyzed by the Kaplan-Meier survival model and expressed as observed overall survi- val.Results:Routine histological examination revealed involved lymph nodes in 9 of the 132 paraaortic nodes(14.52%)of 9 patients. Paraaortic lymph node metastasis were newly detected by immunohistochemistry in 4 (3.25%) of the 123 nodes negative for paraaortic lymph node metastasis by routine histological examination, in 4 of 53 patients(7.55%).Micrometa- stases were observed in 13 lymph nodes(9.85%) of 13 patients(20.97%).Conclusion:The presence of micrometastasis was closely correlated with the size,general style and invasion depth of primary tumor(P<0.05), but was not correlated with age, sex, histological style,location of the primary tumor(P>0.05).The incidence of lymph node micrometastasis was significantly higher in the diffuse type than that in the intestinal type of gastric cancer.The positive metastases in No.2, ,3,6,7,8,9,10,11,12,13,14 lymph nodes were predictive factors for micrometastasis to No.16 lymph nodes.5-year survival rate of gastric cancer patients with No.16 lymph node positive micrometastasis was significantly lower than that with No.16 lymph node negative micrometastasis. |
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