講課-淋巴結(jié)為轉(zhuǎn)移在賁門癌中研究進(jìn)展

SPEAKER:CHENHUINIE-email:lymphnodemicrometastasis（LNMM）

IN

adenocarcinomaoftheesophagogastricjunction(AEG)

Theincidenceofadenocarcinomaoftheesophagogastricjunction

(AEG)isincreasing。

Theincidenceofesophagealadenocarcinomarosefrom0.13for1935-1971to0.74for1974-1989,andtheincidenceofadenocarcinomaoftheesophagogastricjunctionrosefrom0.25to1.34per100,000person-years.whereasthatofdistalgastric

adenocarcinomahassteadilydecreased.2ReferencesCardiagastriccarcinomaORadenocarcinomaoftheesophagogastricjunction(AEG)?

3Definition&classificationhistologyClinicalsiewertAEG

I：between5cmand1cmoralofthejunctionAEGII：between1cmoraland2cmaboralofthejunctionAEGIII

：2cmand5cmaboralofthejunction4siewert1999theinternationalsocietyfordiseaseoftheesophagus(ISDE)THEinternationalgastriccancerassociation(IGCA)ClassificationReferences

theclinicalsymptomsofthesetumorsareoftenquitevagueandtendtointensifyonlygraduallyinseverityoveralongperiodoftime,mostpatientsarefirstdiagnosedwhenthesecarcinomasalreadyarelocallyadvanced。

Theonlychanceforlongtermsurvivalforthesepatientsisacomplete(InternationalUnionAgainstCancer[UICC]R0)removalofthetumor。References5theimportanceofNstatusOneofthekeyfactorsthatdeterminestheprognosisofpatientswithtumorsthroughoutthegastrointestinaltractistheinvolvementbytumorofregionallymphnodes(Nstatus)ForpatientswithAEG,theNstatushasbeenshowntobeanindependentprognosticfactor。recurrenceAlthoughsurgicaltechniqueshaveimproved,theoverallprognosisforpatientswiththesetumorsremainspoorprimarilyduetolocaltumorrecurrenceandthedevelopmentofdistantmetastasesReferences7TherecurrenceratesoftypeI,II,andIIItumorswere57.1%,44.4%,and41.0%,respectively.ThemostfrequentrelapsesitewaslymphogenousintypeI,hematogenousintypeII,anddisseminativeintypeIIItumors.Themediantime-to-recurrenceaftersurgerywas12.6monthsintypeI,12.5monthsintypeII,and12.7monthsintypeIIIdisease,withnosignificantdifference.RecurrencepatternsofesophagogastricjunctionadenocarcinomaaccordingtoSiewert'sclassificationafterradicalresection；AnticancerRes.2014Aug;34(8):4391-7LNMMMicrometastasiswasdefinedastumorcellclustersmeasuringfrom0.2mmto2.0mmintheirgreatestdimension，andarecommonlyidentifiedbyimmuno-histochemistry(IHC)butcanbeconfirmedbyroutineHE。isolatedtumorcells(ITC)aredefinedassingletumorcellsorsmallclustersofcellsmeasuring≤0.2mmintheirgreatestdimension。macrometastasis，MAlymphnodemicrometastasisUICC&AJCCGreeneFL.AJCCCancerStagingManual[M].NewYork:SpringerVerlag,2002:111-119References8References9howtofindimmunohistochemistry(IHC)Ber-EP4AE1/AE3CK19CD44V6(CAM5.2;E-CAD;CCR7；CXCR4)reverse

transcription-polymerasechainreaction（RT-PCR)10howtofindimmunohistochemistry(IHC)Ber-EP4AE1/AE3CK19、20CD44V6(CAM5.2;E-CAD;CCR7；CXCR4)reverse

transcription-polymerasechainreaction（RT-PCR)11Ber-Ep4foundin1990byULatza,GNiedobitek,RSchwarting,HNekarda,HSteinBer-Ep4isanantibodyagainst

twoglycopolypeptidesof34and39kDonthesurface

andthecytoplasmofallepithelialcellsexceptforthe

superficiallayersofsquamousepithelia,parietalcells,

andhepatocytes.Theantibodydoesnotcross-reactwith

mesenchymaltissueincludinglymphoidtissue.stomachMammaryglandReferences12howtofindimmunohistochemistry(IHC)Ber-EP4AE1/AE3CK19CD44V6(CAM5.2;E-CAD;CCR7；CXCR4)reverse

transcription-polymerasechainreaction（RT-PCR)13RT-PCRRT-PCRassayisthoughttobefarmore

sensitivethantheimmunohistochemicalmethod。RT-PCRassayidentifiedlymphnodemicrometastasisin31.3%ofpatients,whereasIHCdetectedlymphnodemicrometastasisin11.3%ofpatients。SeveralstudieshavereportedanRT-PCRanalysistodetectthepositiveexpressionofCEA,CK19,orCK20mRNAin5.3-23.8%oftheLNsthatarefreefromhistologicalmetastasis。.References14problemsfalse-positives&false-negativessensitivity

&

specificityFirst,false-positivesmaybeproducedbyRT-PCRbecauseofthecontaminationorthepresenceofpseudogene

.Second,thereisapossibilityoffalse-negativesbecauseoftheheterogeneousexpressionoftargetmarkers。itssensitivityandspecificitywerereportedas88.9%and96.6%,respectively。References1516sentinelnode(SN)newtreatmentprognosticClinicalSignificanceofLymphNodeMicrometastasissignificanceintraoperationpostoperation

preoperationlymphadenectomyintraoperativeiagnostictool17sentinelnode(SN)newtreatmentprognosticofClinicalSignificanceofLymphNodeMicrometastasissignificanceintraoperationpostoperation

preoperationlymphadenectomyintraoperativeiagnostictoolIfaminimallyinvasivesurgerycouldbeperformedtotreatesophagealcancer,themortalityrateaftersurgeryandthepostsurgicalqualityof

lifecouldimprove.Regardingsurgicaltreatment,minimally

invasive

mucosalresection

(EMR),endoscopicsubmucosaldissection(ESD),andblunt

dissectionarechosenandperformedbasedonthestageand

preoperativeconditionsofpatients.18Thesentinelnode(SN)conceptwasfirstadvocatedby

Mortonetal.inpatientswithmelanoma.SNbiopsyforbreast

cancerandmalignantmelanomahasbeenaccepted

worldwideasausefultechniqueforassessmentoflymph

nodestatus.sentinelnode(SN)

preoperationReferencesDetectionofSentinelNodesOnedaybeforesurgery,3mCi(2mL)of

99mTechnetium-tincolloid(adioisotope(RI)colloid)was

endoscopicallyinjectedintothesubmucosaoftheesophagealwallatfoursites(0.5mLeach)aroundthetumorusingadisposable23-gaugeneedle(MAJ-75,

Olympus,okyo,Japan).Lymphoscintigraphywasperformed2hafterRIinjection.Duringsurgery,theuptakeof

RIineachlymphnodewascountedusingNavigatorGPS

(TYCOHEALTHCARE,Ltd.,Tokyo,Japan).After

surgery,theabsenceofresidualradioactivitywasintraoperativelyconfirmedbyNavigatorGPSinthecervical,mediastinal,andabdominalfields.AlldissectedlymphnodesweremappedandRIuptakewasmeasuredagain.LymphnodeswithRIcountsfivetimesgreaterthan

backgroundlevelswereclassifiedashotnodesandwere

definedassentinelnodes(SNs).

preoperationReferences20sentinelnode(SN)newtreatmentprognosticofClinicalSignificanceofLymphNodeMicrometastasissignificanceintraoperationpostoperation

preoperationlymphadenectomyintraoperativeiagnostictoolLymphaticSpreadandMicroinvolvementin

AdenocarcinomaoftheEsophago-GastricJunctionJournalofSurgicalOncology2006;94:307–315intraoperationLymphnodesweresampledandgroupedintothree

compartments:(1)mediastinallymphnodes,(2)lymph

nodesadjacenttothetumor,(3)upperabdominal

nodes.intraoperationFrequencyandClinicalImpactofLymphNode

MicrometastasisandTumorCellMicroinvolvementin

PatientswithAdenocarcinomaoftheEsophagogastric

Junction

1.MuellerJD,SteinHJ,OyangT,etal.Frequencyandclinicalimpactoflymphnodemicrometastasisandtumorcellmicroinvolvementinpatientswithadenocarcinomaoftheesophagogastricjunction.Cancer2000;89:1874-1882.intraoperationReferencesintraoperativediagnostictoolTodevelopRT-PCRassayasanintraoperativediagnostictoolforthedetectionofLNM,RT-PCRassayneedstoenablerapidanalysisduringoperationaswellastoretainhighsensitivityandspecificity.Yaguchietal.recentlyreportedtheutilityofone-stepnucleicacid

amplification(OSNA).OSNAcantakeapproximately30min

todiagnosethepresenceorabsenceoflymphnode

metastasis.OSNAexaminesonlyCK19

expression,thesensitivityandspecificityinastudyof162

lymphnodesamplesobtainedfrom32patientswithgastric

cancerwere88.9%and96.6%,respectively.thismolecularsystemcouldbea

promisingtoolforintraoperativedetectionofLNMwhen

performingminimallyinvasivesurgerywithpersonalized

lymphadenectomyinpatients.intraoperationReferences25sentinelnode(SN)newtreatmentprognosticofClinicalSignificanceofLymphNodeMicrometastasissignificanceintraoperationpostoperation

preoperationlymphadenectomyintraoperativeiagnostictoolpostoperation2004and2010Noneofthepatientshadreceived

preoperativechemotherapyorradiotherapy.ThepresenceofCK19-positiveor

CD44v6-positivecellswassignificantlyrelatedtodepthofinvasion(