| Objective: To evaluate the prognostic significance and biologic characteristice of the lymphatic micrometastasis in non-small-cell lung cancer(NSCLC) and also to estimate the impact on staging by detection of micrometastasis.Methods: The micrometastasis in pathologically negative regional lymph nodes(n=84) of patients with non-small-cell lung cancer(n=30) were detected by immunohistochemical cytokeratin (CK) analysis. And the expressions of p53 , p21ras in primary pulmonary lesions were also detected by immunochemical methods. Survival rate was calculated by method of Kaplan-Meier and survival difference between groups with and without occult micrometastasis group was compared with Log-Rank test. And the relationship between CK(+) and the expressions of p53, p21ras in primary pulmonary lesions was also anlysised.Result: Micrometastasis were found in 21 lymph nodes(28.89%)of 17 patients . The survival time of patients with micrometastasis who survived was significantly shorter than that of patients without micrometastasis who survived(18 months vs. 53 months, p=0.000). The propotion of patients with micrometastasis whose primary lesions had the expression of p53, p21ras was higher than those without micrometastasis whose primary lesions had noexpressions of p53s p21ras . Comparison between patients with disease staged as NO with nodal micrometastasis and control patients with pathologically proved Nl or N2 stage disease without nodal micrometastasis revealed no stastatical difference in total survival.Conclusions: Immunohistochemical staging for CK offers a rapid, sensitive and useful way of detecting for micrometastasis to the reginal lymph nodes in patients with NSCLC. The patients with such micrometastasis have a poor prognosis, and thus need to be are fully followed up after the initial pulmonary resection. The conventional staging methods can not describe the development of disease accurately, but detection for micrometastasis can make it easier.
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