胰腺腺癌胰腺外神经丛浸润的检测。细胞角蛋白19染色和K-ras突变。

H Suwa, R Hosotani, M Kogire, R Doi, G Ohshio, M Fukumoto, M Imamura
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引用次数: 8

摘要

背景:神经侵犯是胰腺腺癌侵袭性的特征之一。然而,对于广泛剥离腹膜后(尤其是手术缘)后胰腺癌神经浸润的术中检查,尚无系统的研究。方法:采用过氧化物酶标记抗细胞角蛋白19抗体,对17例可切除胰腺丛标本冰冻切片进行术中免疫染色。术后,我们还试图通过对相同样本的K-ras基因直接测序来检测隐匿性微转移。结果:17例患者中4例(23.5%)术中细胞角蛋白19染色阳性。神经浸润边缘阳性患者预后明显差于边缘阴性患者(P < 0.05)。1例患者在神经丛有微转移,通过K-ras突变显示,而细胞角蛋白19染色和术后病理检查均未发现所分析部分受累。在4例细胞角蛋白19染色边缘阳性的患者中,细胞角蛋白19染色诊断神经侵犯与K-ras基因分析一致。结论:术中细胞角蛋白19染色对胰腺癌累及神经丛边缘有重要意义。结果也可作为随访期间的预后指标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Detection of extrapancreatic nerve plexus invasion of pancreatic adenocarcinoma. Cytokeratin 19 staining and K-ras mutation.

Background: Neural invasion is known to be one of the aggressive characteristics of pancreatic adenocarcinoma. However, there have been no systematic studies on intraoperative examination of neural invasion of pancreatic carcinomas after wide dissection of the retroperitoneum, particularly at the surgical margin.

Methods: We performed intraoperative immunostaining on the frozen sections of several excised plexus specimens, using peroxidase-labeled anti-cytokeratin 19 antibody in 17 cases of resectable pancreatic carcinoma. Postoperatively, we also tried to detect occult micrometastasis by direct sequencing of the K-ras gene in the same samples.

Results: Intraoperative staining for cytokeratin 19 was positive in 4 of 17 (23.5%) cases. Patients with margin-positive neural invasion had significantly worse prognosis than patients who were margin negative (P < 0.05). One patient had micrometastasis in the nerve plexus, revealed by K-ras mutation, whereas neither cytokeratin 19 staining nor postoperative pathological investigation detected involvement of the analyzed portion. In the four patients margin-positive for cytokeratin 19 staining, the diagnosis of neural invasion by cytokeratin 19 staining was in agreement with the K-ras gene analysis.

Conclusion: Intraoperative staining for cytokeratin 19 is useful for detecting pancreatic cancer involvement of the neural plexus margin. The results can be also utilized as a prognostic indicator during the follow-up period.

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