ASO：cT1-T2/ cN0期食管癌患者可进行前哨淋巴结探查

目前，食管癌患者淋巴结微转移的临床意义尚不清楚，因此，在进行前哨淋巴结(SN)导航手术时，对淋巴结状态，包括微转移情况进行准确评价具有重要作用。在2013年4月13日在线出版的《外科肿瘤学年鉴》(Annals of Surgical Oncology)杂志上，日本鹿儿岛大学Takahiko Hagihara博士等人发表了一项相关研究结果，该研究旨在借助免疫组化(IHC)方法及逆转录-聚合酶链式反应(RT-PCR)对食管癌患者的淋巴结微转移情况进行确定，并据此考察了SN概念的充分性。该研究最终认为，对于cT1-T2及cN0期食管癌患者而言，即使在经IHC及RT-PCR 确认存在微转移的情况下，仍可以适用SN概念。
该研究共招募了57例食管癌食管癌患者，这些患者病情在术前被确诊为T1-T2 (cT1-T2) 及 N0 (cN0)，并接受了标准食管切除术及淋巴结清扫术治疗。在术前一天时，研究人员通过内窥镜将3 mCi 的99m锝标锡胶体注入至瘤体周围的粘膜下层处。而在手术过程中，通过Navigator GPS测定淋巴结对放射性同位素的吸收情况。最终利用CEA及SCC标记物、苏木精 - 伊红 (HE) 染色及 IHC 方法，对所有淋巴结检验样本进行了RT-PCR考察。
研究发现，HE及IHC方法鉴定出的阳性淋巴结发生率分别为12.3 % (7/57) 及19.3 %(11/57)。RT-PCR结果表明，在经HE 染色法及IHC法确认的46例患者中，有4例患者存在微转移情况。准确率及假阴性率分别为100 %(57/57)及0 % (0/42)。
与食管癌相关的拓展阅读：

• Ann. Surg：抗反流手术后复发增加食管癌风险
• Am J Gastroenterol：内镜切除术后食管癌转移率长期风险与浸润深度相关
• ASO：p53与食管癌化疗缓解率相关
• Radiother Oncol：N1小细胞食管癌治疗首选放化疗
• SCUENCE DAILY:多种生活方式因素或可降低食管癌风险
• J Clin Oncol :食管癌手术应集中于少数外科医师处施行
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Assessment of Sentinel Node Concept in Esophageal Cancer Based on Lymph Node Micrometastasis.
PURPOSE
The clinical significance of lymph node micrometastasis remains unclear in patients with esophageal cancer. Therefore, accurate assessment of lymph node status including micrometastasis is important when performing sentinel node (SN) navigation surgery. The purpose of the present study was to investigate the adequacy of SN concept based on lymph node micrometastasis determined by immunohistochemistry (IHC) and reverse transcription-polymerase chain reaction (RT-PCR) in patients with esophageal cancer.
METHODS
A total of 57 patients with esophageal cancer who were preoperatively diagnosed as having T1-T2 (cT1-T2) and N0 (cN0) were enrolled. They underwent standard esophagectomy with lymph node dissection. One day before surgery, a total of 3 mCi of 99mTechnetium-tin colloid was endoscopically injected into the submucosa around the tumor. During the operation, radioisotope uptake in the lymph nodes was measured using Navigator GPS. All dissected lymph nodes were investigated by RT-PCR using the double marker of CEA and SCC, hematoxylin-eosin (HE) staining, and IHC.
RESULTS
Node-positive incidence identified by HE and IHC was 12.3 % (7/57) and 19.3 % (11/57), respectively. RT-PCR demonstrated micrometastasis in four of 46 patients without nodal metastasis determined by HE staining and IHC. No non-SN metastases were found in 42 patients without micrometastasis identified by IHC and RT-PCR of SN. Accuracy and false negative rates were 100 % (57/57) and 0 % (0/42), respectively.
CONCLUSIONS
SN concept might be acceptable in patients with cT1-T2 and cN0 esophageal cancer, even in the presence of micrometastasis identified by IHC and RT-PCR.