鸡尾酒抗体D2-40/CD34-CK对淋巴结检出数量不足结直肠癌标本的临床病理评价
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摘要
目的探讨鸡尾酒抗体D2-40/CD34-CK双重免疫组化染色在淋巴结检出数量不足的结直肠癌(colorectal cancer,CRC)标本脉管侵犯评估中的应用及意义。方法收集133例淋巴结检出数量<12枚的CRC标本,分别行HE染色及鸡尾酒抗体双重免疫组化染色,比较两种方法在脉管侵犯筛查效果中的差异,并分析应用鸡尾酒抗体免疫组化染色证实的脉管侵犯与临床病理特征及患者总生存期(overall survival,OS)的关系。结果 (1)鸡尾酒抗体D2-40/CD34-CK双重免疫组化染色及HE染色对脉管侵犯的检出率分别为42. 9%(57/133)和21. 8%(29/133),差异有显著性(P <0. 001)。(2)鸡尾酒抗体D2-40/CD34-CK双重免疫组化法证实的脉管侵犯与Dukes分期、浸润深度、临床分期、淋巴结转移、肿瘤出芽相关(P <0. 05)。(3)脉管侵犯、侵犯位置深度、程度及脉管侵犯灶数≤2个灶且癌栓细胞数量≥5. 5个与患者OS密切相关(P <0. 05)。结论鸡尾酒抗体D2-40/CD34-CK双重免疫组化染色对脉管侵犯评估优于常规HE染色切片观察,与肿瘤分期、淋巴结转移及出芽情况密切相关,是患者预后的独立影响因素,可作为淋巴结检出数量不足CRC病例的补充检测指标。
Purpose To investigate the value of application of D2-40/CD34-CK cocktail antibodies by double immunohistochemical staining for assessment of lymphovascular invasion( LVI) and to determine its prognostic significance in colorectal cancer with insufficient lymph node harvest. Methods Specimens from 133 cases of colorectal cancer with less than 12 lymph nodes were selected. HE staining and double immunohistochemical staining of the cocktail antibodies were performed to compare the difference of the two methods in screening for LVI. The The relationship between LVI confirmed by cocktail antibody immunohistochemical staining and clinicopathological characteristics and overall survival( OS) of patients was analyzed. Results( 1) The detection rates of cocktail antibody double immunohistochemical staining and HE staining for LVI were 42. 9%( 57/133) and 21. 8%( 29/133) with statistically significant difference( P < 0. 001).( 2) The presence of LVI confirmed by double staining was significantly associated with Dukes staging,depth of invasion,clinical stages,lymph node metastasis and tumor budding( P < 0. 05).( 3) The presence of LVI,the location and extent of LVI, and the number of tumor cells in thrombus ≥5. 5 for cases with LVI ≤2 clusters,were significantly associated with OS( P < 0. 05). Conclusion D2-40/CD34-CK cocktail antibodies double staining is superior to routine HE staining in assessing LVI. LVI is intimately associated with tumor stage,lymph nodes metastasis and tumor budding,and it is an independent prognostic factor for CRC patients. It should be a supplementary examination for these patients with insufficient lymph node harvest.
Purpose To investigate the value of application of D2-40/CD34-CK cocktail antibodies by double immunohistochemical staining for assessment of lymphovascular invasion( LVI) and to determine its prognostic significance in colorectal cancer with insufficient lymph node harvest. Methods Specimens from 133 cases of colorectal cancer with less than 12 lymph nodes were selected. HE staining and double immunohistochemical staining of the cocktail antibodies were performed to compare the difference of the two methods in screening for LVI. The The relationship between LVI confirmed by cocktail antibody immunohistochemical staining and clinicopathological characteristics and overall survival( OS) of patients was analyzed. Results( 1) The detection rates of cocktail antibody double immunohistochemical staining and HE staining for LVI were 42. 9%( 57/133) and 21. 8%( 29/133) with statistically significant difference( P < 0. 001).( 2) The presence of LVI confirmed by double staining was significantly associated with Dukes staging,depth of invasion,clinical stages,lymph node metastasis and tumor budding( P < 0. 05).( 3) The presence of LVI,the location and extent of LVI, and the number of tumor cells in thrombus ≥5. 5 for cases with LVI ≤2 clusters,were significantly associated with OS( P < 0. 05). Conclusion D2-40/CD34-CK cocktail antibodies double staining is superior to routine HE staining in assessing LVI. LVI is intimately associated with tumor stage,lymph nodes metastasis and tumor budding,and it is an independent prognostic factor for CRC patients. It should be a supplementary examination for these patients with insufficient lymph node harvest.
引文
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[13]赵喜连,郗彦凤,白文启,等.错配修复蛋白和p53蛋白表达与结直肠癌的临床病理关系及其相关性[J].临床与实验病理学杂志,2016,32(4):370-374.
[2]陆明,胡孔旺,王宜文,等.叉头框M1在结直肠癌中的表达及临床意义[J].临床与实验病理学杂志,2017,33(8):847-852.
[3]Ueno H,Murphy J,Jass J R,et al.Tumour‘budding’as an index to estimate the potential of aggressiveness in rectal cancer[J].Histopathology,2002,40(2):127-132.
[4]刘仙花,余英豪,叶显宗.林奇综合征临床病理筛查的相关进展[J].实用肿瘤杂志,2018,33(3):277-282.
[5]Kojima M,Shimazaki H,Iwaya K,et al.Pathological diagnostic criterion of blood and lymphatic vessel invasion in colorectal cancer:a framework for developing an objective pathological diagnostic system using the Delphi method,from the Pathology Working Group of the Japanese Society for Cancer of the Colon and Rectum[J].J Clin Pathol,2013,66(7):551-558.
[6]Betge J,Pollheimer M J,Lindtner R A,et al.Intramural and extramural vascular invasion in colorectal cancer:prognostic significance and quality of pathology reporting[J].Cancer,2012,118(3):628-638.
[7]Budczies J,Klauschen F,Sinn B V,et al.Cutoff finder:a comprehensive and straightforward Web application enabling rapid biomarker cutoff optimization[J].PLo S One,2012,7(12):e51862.
[8]Edge S B,Compton C C.The American Joint Committee on Cancer:the 7th edition of the AJCC cancer staging manual and the future of TNM[J].Ann Surg Oncol,2010,17(6):1471-1474.
[9]Lim S B,Yu C S,Jang S J,et al.Prognostic significance of lymphovascular invasion in sporadic colorectal cancer[J].Dis Colon Rectum,2010,53(4):377-384.
[10]Parnaby C N,Scott N W,Ramsay G,et al.Prognostic value of lymph node ratio and extramural vascular invasion on survival for patients undergoing curative colon cancer resection[J].Br JCancer,2015,113(2):212-219.
[11]Bosch S L,Teerenstra S,de Wilt J H,et al.Predicting lymph node metastasis in pT1 colorectal cancer:a systematic review of risk factors providing rationale for therapy decisions[J].Endoscopy,2013,45(10):827-834.
[12]Chang H C,Huang S C,Chen J S,et al.Risk factors for lymph node metastasis in pT1 and p T2 rectal cancer:a single-institute experience in 943 patients and literature review[J].Ann Surg Oncol,2012,19(8):2477-2484.
[13]赵喜连,郗彦凤,白文启,等.错配修复蛋白和p53蛋白表达与结直肠癌的临床病理关系及其相关性[J].临床与实验病理学杂志,2016,32(4):370-374.