講課淋巴結(jié)為轉(zhuǎn)移在賁門癌中的研究進(jìn)展Theincidenceofadenocarcinomaoftheesophagogastricjunction

(AEG)isincreasing。

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

adenocarcinomahassteadilydecreased.2PeraM,CameronAJ,TrastekVF,CarpenterHA,Zinsmeister

AR.Increasingincidenceofadenocarcinomaoftheesophagusandesophagogastricjunction.Gastroenterology1993;104:510–3.BlotWJ,DevesaSS,KnellerRW,etal.:Risingincidenceof

adenocarcinomaoftheesophagusandgastriccardia.JAMA

1991;265:1287–1289.ReferencesCardiagastriccarcinomaORadenocarcinomaoftheesophagogastricjunction(AEG)?

3Definition&classificationhistologyClinicalsiewertAEG

I：between5cmand1cmoralofthejunctionAEGII：between1cmoraland2cmaboralofthejunctionAEGIII

：2cmand5cmaboralofthejunction4siewert1999theinternationalsocietyfordiseaseoftheesophagus(ISDE)THEinternationalgastriccancerassociation(IGCA)Classification5.SiewertJR,SteinHJ:Classificationofadenocarcinomaoftheoesophagogastricjunction.BrJSurg1998;85:1457–1459References

theclinicalsymptomsofthesetumorsareoftenquitevagueandtendtointensifyonlygraduallyinseverityoveralongperiodoftime,mostpatientsarefirstdiagnosedwhenthesecarcinomasalreadyarelocallyadvanced。

Theonlychanceforlongtermsurvivalforthesepatientsisacomplete(InternationalUnionAgainstCancer[UICC]R0)removalofthetumor。TytgatGN.Barrett’sesophagus:isitallthatbad?CanJGastroenterol1999;13:385–8References5theimportanceofNstatusOneofthekeyfactorsthatdeterminestheprognosisofpatientswithtumorsthroughoutthegastrointestinaltractistheinvolvementbytumorofregionallymphnodes(Nstatus)ForpatientswithAEG,theNstatushasbeenshowntobeanindependentprognosticfactor。YamashitaH,KataiH,MoritaS,etal.OptimalextentoflymphnodedissectionforSiewerttypeIIesophagogastricjunctioncarcinoma.Annalsofsurgery2011;254:274-280.recurrenceAlthoughsurgicaltechniqueshaveimproved,theoverallprognosisforpatientswiththesetumorsremainspoorprimarilyduetolocaltumorrecurrenceandthedevelopmentofdistantmetastasesNatsugoeS,MuellerJD,KijimaF,AridomeK,ShimadaM,ShiraoK,etal.Extranodalconnectivetissueinvasionandtheexpressionofdesmosomalglycoprotein1insquamouscellcarcinomaoftheoesophagus.BrJCancer1997;75:892–7.SiewertJR,SteinHJ,SendlerA,FinkU.Surgicalresectionforcancerofthecardia.SeminSurgOncol1999;17:125–31.JaklRJ,MiholicJ,KollerR,MarkisE,WolnerE.Prognosticfactorsinadenocarcinomaofthecardia.AmJSurg1995;169:316–9ReferencesNigroJJ,DeMeesterSR,HagenJA,DeMeesterTR,PetersJH,KiyabuM,etal.Nodestatusintransmuralesophagealadenocarcinomaandoutcomeafterenblocesophagectomy.JThoracCardiovascSurg1999;117:960–87TherecurrenceratesoftypeI,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,2002:111-119References8MuellerJD,SteinHJ,OyangT,etal.Frequencyandclinicalimpactoflymphnodemicrometastasisandtumorcellmicroinvolvementinpatientswithadenocarcinomaoftheesophagogastricjunction.Cancer2000;89:1874-1882.References9howtofindimmunohistochemistry(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.LatzaU,NiedobitekG,SchwartingR,etal.:Ber-EP4:Newmonoclonalantibodywhichdistinguishesepitheliafrommesothelial.JClinPathol1990;43:213–219.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。.AberrantGeneMethylationintheLymphNodesProvidesaPossibleMarkerforDiagnosingMicrometastasisinGastriccancer

AnnSurgOncol(2010)17:1177–1186Assessmentofmelanoma-initiatingcellmarkersandconventionalparametersinsentinellymphnodesofmalignantmelanoma;ActaMed.Okayama,2015Vol.69,No.1,pp.17-27References14problemsfalse-positives&false-negativessensitivity

&

specificityFirst,false-positivesmaybeproducedbyRT-PCRbecauseofthecontaminationorthepresenceofpseudogene

.Second,thereisapossibilityoffalse-negativesbecauseoftheheterogeneousexpressionoftargetmarkers。itssensitivityandspecificitywerereportedas88.9%and96.6%,respectively。Clinicalsignificanceofmoleculardiagnosisforgastriccancerlymphnodemicrometastasis；WorldJGastroenterol2014October14;20(38):13728-13733CurrentStatusandScopeofLymphNode；JGastricCancer2015;15(1):1-9/10.5230/jgc.20References1516sentinelnode(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)VeronesiU,PaganelliG,GalimbertiV,etal.Sentinel-nodebiopsytoavoidaxillarydissectioninbreastcancerwithclinicallynegativelymph-nodes.Lancet.1997;349:1864–7.EdwardsMJ,MartinKD,McMastersKM.Lymphaticmappingandsentinellymphnodebiopsyinthestagingofmelanoma.SurgOncol.1998;7:51–7.

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).AssessmentofSentinelNodeConceptinEsophagealCancerBasedonLymphNodeMicrometastasisAnnSurgOncol(2013)20:3031–3037

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.YaguchiY,SugasawaH,TsujimotoH,etal.One-stepnucleicacidamplification(OSNA)fortheapplicationofsentinelnodeconceptingastriccancer.AnnSurgOncol.2011;18:2289–96.intraoperationReferences25sentinelnode(SN)newtreatmentprognosticofClinicalSignificanceofLymphNodeMicrometastasissignificanceintraoperationpostoperation

preoperationlymphadenectomyintraoperativeiagnostictool1.RuY,ZhangL,ChenQ,etal.Detectionandclinicalsignificanceoflymphnodemicrometastasisingastriccardiaadenocarcinoma.TheJournalofinternationalmedicalresearch2012;40:293-299.postoperation2004and2010Noneofthepatientshadreceived

preoperativechemotherapyorradiotherapy.ThepresenceofCK19-positiveor

CD44v6-positivecellswassignificantlyrelatedtodepthofinvasion(P=0.043andP=0.046,respectively)andLauren

classification(P=0.019andP=0.007,respectively),butnottoage,sex,tumoursize

ordegreeofdifferentiation.1.SchurrPG,YekebasEF,KaifiJT,etal.Lymphaticspreadandmicroinvolvementinadenocarcinomaoftheesophago-gastricjunction.Journalofsurgicaloncology2006;94:307-315.SurvivalSchurr