위암에서 면역조직화학적으로 확인된 림프관 침윤과 림프관 증식이 갖는 의미

Abstract

ABSTRACT

Significance of Lymphatic Invasion and Lymph Vessel Density Identified Immunohistochemically in Gastric Cancer

Kim, Dong Hwan Advisor : Prof. Lee, Mi Ja/Cho, Soo Hyung, Ph.D. Department of Medicine, Graduate School of Chosun University

Background: The lymphatic invasion (LI) is the significant risk factor for nodal metastasis in gastric cancer. However, the diagnosis of LI is subjective and often inaccurate because of the difficulty of detecting lymphatic vessels with conventional H&E staining. This study aimed to evaluate the significance of LI and lymphatic vessel density (LVD) in patients with gastric cancer. Methods: The LI and LVD were immunohistochemically identified using a new selective marker of lymphatic endothelium, D2-40, in surgical specimens resected for gastric cancer. The positive and negative predictive values for nodal metastasis were comparatively examined for LI detected by H&E staining (LI-HE) and by immunohistochemical staining using D2-40 (LI-IHC). The results were compared with both clinicopathological factors (age, sex, Lauren classification type, histologic grade, tumor size, pT stage, lymph node metastasis, distant metastasis and stage) and the overall survival. Results: The lymphatic vessel density (LVD) by D2-40 was extremely higher in the adenocarcinoma than normal gastric tissue. Sensitivity for LN metastasis LI-IHC was higher than by LI-HE. LI-IHC was significantly correlated with depth of tumor invasion (pT) and lymph node stage (pN). Univariate analysis showed tumor size, pT, pN and stage to have a significant correlation on survival. Conclusion: Immunohistochemical identification of lymphatics is useful to increase the accuracy of diagnosing LI in gastric cancer. LI-IHC is superior to LI-HE as a predictor of nodal metastasis. Therefore, The use of D2-40 immunostaining for the routine evaluation of LI is recommended in gastric cancer. Also, LI-IHC and LVD are an additional prognostic marker, and provides useful information for tumor aggressiveness and planning treatment strategies in gastric cancer patients.