cN0甲状腺乳头状癌中央区淋巴结微转移的初步研究
|
摘要
目的探讨cN0甲状腺乳头状癌中央区淋巴结的微转移情况,探讨逆转录聚合酶链反应(RT-q PCR)技术对诊断淋巴结微转移灶的价值,并筛选微转移的临床病理高危因素。方法选取2012年11月~2014年3月浙江省肿瘤医院收治的cN0甲状腺乳头状癌患者48例,对从中取到136个病理证实无转移的中央区淋巴结分别用免疫组化和RT-q PCR检测CK19的表达情况。将患者的各项临床病理相关因素作为自变量,以淋巴结微转移因素作为因变量,应用二分类变量Logistic回归模型进行多因素分析,以期发现微转移可能的高危因素。结果免疫组化检测CK19为15.44%(21/136),RT-q PCR法的阳性检出率为82.35%(112/136)。RT-q PCR法与免疫组化法比较具有显著差异。Logistic回归模型中筛选出肿瘤甲状腺包膜侵犯是c N0甲状腺乳头状癌中央区淋巴结微转移的危险因素。结论应用RT-q PCR检测CK19表达,可提高对甲状腺癌的淋巴结微转移阳性检出率。肿瘤甲状腺包膜侵犯是淋巴结微转移的独立危险因素。
Objective To investigate the micrometastasis of lymph node in the central compartment of cN0 papillary thyroid carcinoma,to explore the value of reverse transcription polymerase chain reaction(RT-q PCR) in the diagnosis of lymph node micrometastasis,and to screen the clinical pathological risk factors of micrometastasis.Methods A total of48 patients with cN0 thyroid papillary carcinoma who were admitted to Zhejiang Cancer Hospital from November 2012 to March 2014 were enrolled in this study.The expression of CK19 was detected by immunohistochemistry and RT-q PCR in 136 lymph nodes in the central zone collected from them,which was pathologically confirmed without metastasis.The clinicopathological factors of patients were taken as independent variables,and lymph node micrometastasis factors were taken as the dependent variables.Multivariate analysis was applied by binary variables Logistic regression model,so as to explore the possible risk factors of micrometastasis.Results CK19 was detected by immunohistochemistry in 15.44%(21/136).The positive rate of CK19 was 82.35%(112/136) by RT-q PCR.RT-q PCR method and immunohistochemical method were compared,and the differences were significant.Logistic regression analysis showed that tumor thyroid capsule invasion was the risk factor of central zone lymph node micrometastasis in c N0 papillary thyroid carcinoma.Conclusion The test of CK19 expression by RT-q PCR can increase the positive detection rate of lymph node micrometastasis in thyroid carcinoma.Tumor thyroid capsule invasion is an independent risk factor for lymph node micrometastasis.
Objective To investigate the micrometastasis of lymph node in the central compartment of cN0 papillary thyroid carcinoma,to explore the value of reverse transcription polymerase chain reaction(RT-q PCR) in the diagnosis of lymph node micrometastasis,and to screen the clinical pathological risk factors of micrometastasis.Methods A total of48 patients with cN0 thyroid papillary carcinoma who were admitted to Zhejiang Cancer Hospital from November 2012 to March 2014 were enrolled in this study.The expression of CK19 was detected by immunohistochemistry and RT-q PCR in 136 lymph nodes in the central zone collected from them,which was pathologically confirmed without metastasis.The clinicopathological factors of patients were taken as independent variables,and lymph node micrometastasis factors were taken as the dependent variables.Multivariate analysis was applied by binary variables Logistic regression model,so as to explore the possible risk factors of micrometastasis.Results CK19 was detected by immunohistochemistry in 15.44%(21/136).The positive rate of CK19 was 82.35%(112/136) by RT-q PCR.RT-q PCR method and immunohistochemical method were compared,and the differences were significant.Logistic regression analysis showed that tumor thyroid capsule invasion was the risk factor of central zone lymph node micrometastasis in c N0 papillary thyroid carcinoma.Conclusion The test of CK19 expression by RT-q PCR can increase the positive detection rate of lymph node micrometastasis in thyroid carcinoma.Tumor thyroid capsule invasion is an independent risk factor for lymph node micrometastasis.
引文
[1]Mai KT,Truong L D,Ball C G,et al.Lymphatic endothelial cancerization in papillary thyroid carcinoma:Hidden evidence of lymphatic invasion[J].Pathology International,2015,65(5):220-230.
[2]Erdem H,Gündogdu C,Sipal S.Correlation of E-cadherin,VEGF,COX-2 expression to prognostic parameters in papillary thyroid carcinoma[J].Exp Mol Pathol,2011,90(3):312-317.
[3]Xing M.Molecular pathogenesis and mechanisms of thyroid cancer[J].Nat Rev Cancer,2013,13(3):184-199.
[4]沈樑,黄颖烽,梁柳森,等.甲状腺癌前哨淋巴结微转移分子检测及其临床意义[J].临床医学,2008,28(11):98-99.
[5]王建军.RT-PCR法检测前哨淋巴结ck19在甲状腺癌治疗中的应用研究[J].牡丹江医学院学报,2012,33(6):29-30.
[6]Keshtgar M,Aresti N,Macneil F,et al.Establishing axillary Sentinel Lymph Node Biopsy(SLNB)for early breast cancer in the United Kingdom:a survey of the national training program[J].European Journal of Surgical Oncology,2010,36(4):393-398.
[7]Sadeghi R,Alesheikh G,Zakavi SR,et al.Added value of blue dye injection in sentinel node biopsy of breast cancer patients:Do all patients need blue dye?[J].International Journal of Surgery,2014,12(4):325-328.
[8]Liu Z,Yu P,Xiong Y,et al.Significance of CK19,TPO,and HBME-1 expression for diagnosis of papillary thyroid carcinoma[J].Int J Clin Exp Med,2015,8(3):4369-4374.
[9]Paunovic I,Isic T,Havelka M,et al.Combined immunohistochemistry for thyroid peroxidase,galectin-3,CK19 and HBME-1 in differential diagnosis of thyroid tumors[J].APMIS,2012,120(5):368-379.
[10]Gabryel B,Brominski G,Owecki M,et al.The prevalence of thyroid nodular disease in patients with increased titers of anti-thyroidal peroxidase antibodies[J].Neuro Endocrinol Lett,2012,33(4):442-445.
[11]〔美〕莱斯利.索宾,〔加〕玛丽.高斯伯德罗维兹,〔德〕克里斯坦.维特金德,主编.周清华,孙燕,主译.恶性肿瘤TNM分期(第7版)[M].天津:天津科技翻译出版公司,2012:57-62.
[12]田君才,杜国亮,张桂霞.人工免疫组化判定结果与灰度值相关性[J].临床与实验病理学杂志,2010,26(1):112-113.
[13]Caminha LS,Momesso DP,Vaisman F,et al.Long-term follow-up of patients with differentiated thyroid cancer who had negative 131I whole-body scan at first evaluation after treatment[J].Clin Nucl Med,2013,38(10):765-769.
[14]Ni YQ,Liu QJ,Tian YX.Clinical value of cancer cells joint detection in peripheral blood plasma of thyroid cancer patients[J].Chinese-German J Clin Oncol,2014,13(11):518-522.
[15]郭苗,张冠军,Guo Miao,等.甲状腺微小乳头状癌CK19和CD56的表达及与疾病进展的关系[J].西南国防医药,2015,25(10):1098-1100.
[16]Hu Y,Li M,Cai W.Exploration on Correlation between Thyroid Cancer and Cytokeratin 19 as well as Thyroid Transcription Factors[J].Health Education&Health Promotion,2013.
[17]Gong L,Chen P,Liu X,et al.Expressions of D2-40,CK19,galectin-3,VEGF and EGFR in papillary thyroid carcinoma.[J].Gland Surgery,2012,1(1):25-32.
[18]张磊,杨进宝樊,宇芳,等.c N0甲状腺乳头状癌淋巴结转移的危险因素分析[J].中国癌症杂志,2016,26(1):73-79.
[19]林晓东,陈晓意,杜嘉林,等.c N0期甲状腺乳头状癌中央区淋巴结转移的影响因素分析[J].中国普外基础与临床杂志,2015,22(6):683-687.
[20]王萍萍,曹慧,韩晓婷,等.临床c N0期甲状腺微小乳头状癌中央区淋巴结转移危险因素分析及手术方式探讨[J].中华内分泌外科杂志,2015,9(1):6-8.
[21]宋方彬,翁明哲,徐军明,等.c N0期甲状腺乳头状癌中央区淋巴结转移影响因素分析[J].中华内分泌外科杂志,2016,10(4):291-293.
[22]顾梓群,单成祥,刘佳,等.c NO甲状腺乳头状癌中央区淋巴结转移规律及危险因素分析[J].第二军医大学学报,2016,37(5):544-547.
[23]马宁,李进让,郭红光.c N0甲状腺乳头状癌患者Ⅵ区淋巴结转移的危险因素分析[J].临床耳鼻咽喉头颈外科杂志,2016,20(8):641-644.
[2]Erdem H,Gündogdu C,Sipal S.Correlation of E-cadherin,VEGF,COX-2 expression to prognostic parameters in papillary thyroid carcinoma[J].Exp Mol Pathol,2011,90(3):312-317.
[3]Xing M.Molecular pathogenesis and mechanisms of thyroid cancer[J].Nat Rev Cancer,2013,13(3):184-199.
[4]沈樑,黄颖烽,梁柳森,等.甲状腺癌前哨淋巴结微转移分子检测及其临床意义[J].临床医学,2008,28(11):98-99.
[5]王建军.RT-PCR法检测前哨淋巴结ck19在甲状腺癌治疗中的应用研究[J].牡丹江医学院学报,2012,33(6):29-30.
[6]Keshtgar M,Aresti N,Macneil F,et al.Establishing axillary Sentinel Lymph Node Biopsy(SLNB)for early breast cancer in the United Kingdom:a survey of the national training program[J].European Journal of Surgical Oncology,2010,36(4):393-398.
[7]Sadeghi R,Alesheikh G,Zakavi SR,et al.Added value of blue dye injection in sentinel node biopsy of breast cancer patients:Do all patients need blue dye?[J].International Journal of Surgery,2014,12(4):325-328.
[8]Liu Z,Yu P,Xiong Y,et al.Significance of CK19,TPO,and HBME-1 expression for diagnosis of papillary thyroid carcinoma[J].Int J Clin Exp Med,2015,8(3):4369-4374.
[9]Paunovic I,Isic T,Havelka M,et al.Combined immunohistochemistry for thyroid peroxidase,galectin-3,CK19 and HBME-1 in differential diagnosis of thyroid tumors[J].APMIS,2012,120(5):368-379.
[10]Gabryel B,Brominski G,Owecki M,et al.The prevalence of thyroid nodular disease in patients with increased titers of anti-thyroidal peroxidase antibodies[J].Neuro Endocrinol Lett,2012,33(4):442-445.
[11]〔美〕莱斯利.索宾,〔加〕玛丽.高斯伯德罗维兹,〔德〕克里斯坦.维特金德,主编.周清华,孙燕,主译.恶性肿瘤TNM分期(第7版)[M].天津:天津科技翻译出版公司,2012:57-62.
[12]田君才,杜国亮,张桂霞.人工免疫组化判定结果与灰度值相关性[J].临床与实验病理学杂志,2010,26(1):112-113.
[13]Caminha LS,Momesso DP,Vaisman F,et al.Long-term follow-up of patients with differentiated thyroid cancer who had negative 131I whole-body scan at first evaluation after treatment[J].Clin Nucl Med,2013,38(10):765-769.
[14]Ni YQ,Liu QJ,Tian YX.Clinical value of cancer cells joint detection in peripheral blood plasma of thyroid cancer patients[J].Chinese-German J Clin Oncol,2014,13(11):518-522.
[15]郭苗,张冠军,Guo Miao,等.甲状腺微小乳头状癌CK19和CD56的表达及与疾病进展的关系[J].西南国防医药,2015,25(10):1098-1100.
[16]Hu Y,Li M,Cai W.Exploration on Correlation between Thyroid Cancer and Cytokeratin 19 as well as Thyroid Transcription Factors[J].Health Education&Health Promotion,2013.
[17]Gong L,Chen P,Liu X,et al.Expressions of D2-40,CK19,galectin-3,VEGF and EGFR in papillary thyroid carcinoma.[J].Gland Surgery,2012,1(1):25-32.
[18]张磊,杨进宝樊,宇芳,等.c N0甲状腺乳头状癌淋巴结转移的危险因素分析[J].中国癌症杂志,2016,26(1):73-79.
[19]林晓东,陈晓意,杜嘉林,等.c N0期甲状腺乳头状癌中央区淋巴结转移的影响因素分析[J].中国普外基础与临床杂志,2015,22(6):683-687.
[20]王萍萍,曹慧,韩晓婷,等.临床c N0期甲状腺微小乳头状癌中央区淋巴结转移危险因素分析及手术方式探讨[J].中华内分泌外科杂志,2015,9(1):6-8.
[21]宋方彬,翁明哲,徐军明,等.c N0期甲状腺乳头状癌中央区淋巴结转移影响因素分析[J].中华内分泌外科杂志,2016,10(4):291-293.
[22]顾梓群,单成祥,刘佳,等.c NO甲状腺乳头状癌中央区淋巴结转移规律及危险因素分析[J].第二军医大学学报,2016,37(5):544-547.
[23]马宁,李进让,郭红光.c N0甲状腺乳头状癌患者Ⅵ区淋巴结转移的危险因素分析[J].临床耳鼻咽喉头颈外科杂志,2016,20(8):641-644.