Application Of Ber-Ep4 Antibody Detection Joint With CD44v6 In The Lower Mediastinal Lymph Nodes Micrometastasis Of The Patients With Siewert Type Ⅱ Adenocarcinoma Of The Esophagogastric Junction

Objective: For Siewert type II adenocarcinoma of the esophagogastric junction(AEJ), the optimal surgical approach andextent of lymph nodes dissection remain controversial. Immunohistochemistry(IHC) have been reported to be available for identifying lymph nodes micrometastasis(LNMM) in patients with AEJ.Methods: This was a retrospective case series of patients who underwent R0 resection and lower medistinal lymphadenectomy from January 2010 to June 2015 at Fujian Medical University Union Hospital for Siewert type II AEJ, whose outcomes were analyzed retrospectively. 1325 lymph nodes were collected from 49 patients, grouped into two compartments:(1) lower mediastinal,(2) paracardial,(3)abdominal lymph nodes. The first group was examined by using two monoclonal antibodies against Ber-Ep4 and CD44v6.Results: The incidence of positivelymph nodes tested by routine histological examination inmediastinal,paracardial and abdominal was 7.7%、18.2%、18.9%,respectively. Of these, 18 patients(36.7%) for Ber-Ep4 and 16 patients(32.7%) for CD44v6. While in routine histological diagnosis, it was 7 patients(14%). when combined IHC with HE staining, the incidence of positive mediastinal lymph nodes was increased into 37 lymph nodes(23.9%) in 28 patients(57.1%).Micrometastases for Ber-Ep4 and CD44v6 were associated with depth of tumor invasion(P=0.020 and P=0.037, respectively), histopathological nodal status(P=0.024 and P=0.01, respectively) and Lauren classification(P=0.038 and P=0.02,respectively).The 3-year and 5-year survival rate for all patients was 66.4% and50.4% respectively, While the patients with or without LNMM was 51.0% and79.8%, 29.2% and 68.4%(P=0.006), respectively. Patients with positive Ber-Ep4 cells had a lower survival, but with no statistic significance(P=0.058). CD44v6 positive group had a significantly reduced survival(P<0.001). In patients with negative lower mediastinal lymph nodes group, patients without LNMM obtained a significant survival benefit than those with(P=0.021).Conclusions: 1. It is necessary to test for LNMM with those negative lymph nodes in routine examination. 2. Thorough lower mediastinal lymphadenectomy in a invasive approach should be considered, as indicator by its high occurrence and prognostic predictor. 3. Ber-Ep4 and CD44v6 were shown to be great markers for detecting LNMM.