| OBJECTIVES: The main causes of death of the patient with esophageal who had undergone surgical therapy were the recurrence and metastasis of the disease. So appraising the situation of lymph node metastasis precisely has a significant clinical value. The purpose of this study was to estimate the diagnostic value of immumohistochemical methods for detection of lymph node micrometastasis; to reveal the correlation between the lymph node micrometastasis and the clinicopathological finding; to reveal the rule of micrometastasis; to investigate whether the presence of lymph node micrometastasis had prognostic value; and to explored what were the main independent prognostic factors.METHODS: We re-examined the presence of micrometastasis in 955 lymph nodes from 100 patients with pNO disease who underwent curative esophagectomy during June 1997 and June 1998. These patients were selected randomly and their data were recorded particularly. The specimens of lymph nodes had been paraffin-embedded. The sections of the specimens were immunostained using a monoclonal antibody cytokeratin cocktail (AE1/AE3), a monoclonal antibody EMA and a monoclonal antibody E-cadherin. The lymph node micrometastasis was detectedby immunohistochemical S-P method and a retrospective analysis was performed combined with data of clinicopathology and the follow-up information. Overall survival was determined from the time of peration to the time of death or the last follow-up. The time of last follow-up was 2003-7. The mean follow-up period was 44.63 months. RESULTS: The staining of antibody AE1/AE3 was observed in the cytoplasm of the cancer cell, while that of antibody EMA was in the membrane and cytoplasm of the cancer cell. The staining of antibody E-cadherin was also observed in the membrane and cytoplasm. The cancer cell distributed in every different part of lymph node as one individual positive cell, two individual cells, or positive cluster. Micrometastasis was detected in 25 lymph nodes (2.63%) from 21 patients (21.21%). Statistical analysis showed that there was significant difference in detection of micrometastasis between immunohistochemical methods and routine method (P<0.05) ; The antibody E-cadherin had significant difference compared with the others two methods (P0.05) ; The antibody AE1/AE3 was no difference compared with the antibody EMA (P0.05), but was better for detection. Micrometastasis was not associated with depth of invasion differentiation of tumor or sex (P=0.536, 0.545, 0.349 respectively) . But it was associated with location of tumor. Lower thoracic segment group had difference compared with middlethoracic and upper thoracic segment groups (P=0.014) . The 1-year and 3-year overall survival of the patients without micrometastasis were 79.49% and 64.10% respectively, while those of the patients with micrometastasis were 89.43% and 66.67% respectively . The presence of micrometastasis did not appear to be associated with the patients' survival (P=0.664 ) . Cox regression analysis shows differentiation of tumor was the most independently associated with the patients'survival (P0.007) , followed by pT stage (P=0.009) . However, the patients' survival was not associated with postoperative treatment (P=0.207) , lymph node micrometastasis (P=0.286) ,age (P=0.412), location of tumor (P=0.426) and style of operation (/? -0.984) .CONCLUSIONS: Lmmunohistochemical detection of lymph node micrometastasis may be an indicator of lymphatic dissemination of tumour cells. We suggested that the definite criterion for micrometastasis size was less than 0.5mm in diameter. The antibody AE1/AE3 could used to be a method for detection of lymph node micrometastasis. And we could detect more slices to improve the positive rate. We did not propose to use the antibody EMA to detect micrometastasis. And the antibody E-cadherin could no be used as a detector for micrometastasis. The presence of micrometastasis was associated with the location of oesophageal squamous cell carcinoma.And it was not associated with the depth of invasion t...
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