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目的目前,尚无检测技术可准确判断肺癌前哨淋巴结(sentinel lymph node,SLN)微转移。本研究探讨CK19和MAGE-A3表达与非小细胞肺癌(non-small cell lung cancer,NSCLC)SLN微转移的相关性及临床价值。方法选择山东大学附属山东省肿瘤医院胸外科32例接受手术治疗的临床Ⅰ~ⅡA期NSCLC患者,术中联合应用染色法(异舒泛蓝溶液)和放射同位素法(99 Tc硫胶体检测)找寻SLN,并采用免疫组化技术检测SLN及非前哨淋巴结(non-sentinel lymph node,non-SLN)中CK19和MAGE-A3抗体的表达。结果 32例患者均检测出SLN,共清除淋巴结598枚,其中SLN 103枚,non-SLN 495枚。平均每例患者清除淋巴结(18.69±8.13)枚,清除SLN(3.22±1.74)枚。免疫组化法检测到20例患者44枚SLN中CK19表达阳性,19例患者31枚SLN中MAGE-A3抗体表达阳性。SLN免疫组化检查阳性率为42.72%,明显高于常规HE染色的阳性率(25.24%),P=0.01。SLN的阳性表达率与临床病理分期有关,P<0.05;而与性别、年龄、肿瘤部位、分化程度、肿瘤大小和肿瘤类型无关,P>0.05。结论 CK19和MAGE-A3是判断淋巴结微转移较好的分子标志物,通过免疫组化技术检测SLN中CK19和MAGE-A3表达有助于评估区域淋巴结微转移状况。
Objective Currently, no detection technique can accurately determine the micrometastasis of sentinel lymph node (SLN) in lung cancer. This study was to investigate the correlation between the expression of CK19 and MAGE-A3 and the micrometastasis of SLN in non-small cell lung cancer (NSCLC). Methods Thirty-two patients with clinical stage Ⅰ-ⅡA NSCLC who underwent surgery in the Department of Thoracic Surgery, Shandong Tumor Hospital Affiliated to Shandong University were enrolled in this study. They were stained with Isotonic Blue solution and radioisotope (99Tc sulfur colloid assay) SLN. Immunohistochemistry was used to detect the expression of CK19 and MAGE-A3 antibodies in SLN and non-sentinel lymph node (non-SLN). Results All 32 patients were detected SLN, a total of 598 lymph nodes were cleared, including 103 SLNs and 495 non-SLNs. On average, each patient had lymph node dissection (18.69 ± 8.13) and SLN (3.22 ± 1.74). Immunohistochemistry detected positive expression of CK19 in 44 SLNs in 20 patients, and positive expression of MAGE-A3 antibodies in 31 SLNs in 19 patients. The positive rate of SLN immunohistochemistry was 42.72%, which was significantly higher than that of routine HE staining (25.24%), P = 0.01. The positive expression rate of SLN was related to the clinicopathological stage (P <0.05), but not related to gender, age, tumor location, differentiation degree, tumor size and tumor type (P> 0.05). Conclusions CK19 and MAGE-A3 are molecular markers for judging the micrometastasis of lymph nodes. To detect the expression of CK19 and MAGE-A3 in SLN by immunohistochemistry is helpful to evaluate the regional lymph node micrometastasis.