| Objective:To explore the clinical significance of detecting micro-metastasis in lymph nodes of patients with stage I non-small cell lung cancer (NSCLC) by reverse transcriptase polymerase chain reaction (RT-PCR). Methods:1. To apply an improved RT-PCR assay with cytokeratin (CK)19 as the gene marker for the detection of occult micrometastasis in lymph nodes of stage I NSCLC.2. Regional lymph nodes(n=92) were obtained from 36 patients with stage I NSCLC who underwent lobectomy. Each lymph nodes was bisected. One half was subjected to routine histological examination (HE), and the other half was subjected to CK19 RT-PCR.Results:1. No false-positive or false-negative results were obtained in the reliability tests. The sensitivity of RT-PCR technique was 10"7 after a 2-round amplication in this study.2. The positive rate of CK19 mRNA expression in 36 patients with stage I NSCLC was 41. 6%(15/36). The occult micrometastasis in lymph nodes of stage I NSCLC were closely related to the tumor size and histological differentiation(p<0. 05 or p<0.01). But no correlationwith pathological classification, tumor location, age, sex and smoking history(P>0. 05).3. 23% of stage la NSCLC and 52. 1% of Ib NSCLC according to p-TNM were up to stage Ha, lib or Ilia by using RT-PCR amplification of CK19 mRNA. Especially, 25%(9/36) patients of stage I NSCLC were diagnosis as stage Ilia according to molecular p-TNM. Conclusion:1. RT-PCR technique is a specific and sensitive method to detection occult micrometastasis in patients with pNO NSCLC. Comparing with HE, the RT-PCR method can make more accurate assessment of metastatic status in lymph nodes.2. The detection of CK19 mRNA might have important clinical significance in molecular diagnosis in stage I NSCLC and useful in defining groups of patients with a poor prognosis who could benefit from adjuvant systemic treatment.
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