Expression And Clinical Significance Of CK20, CDX2 And VEGF-C In D3 Lymph Nodes In Rectal Cancer

Objective: Lymph nodes metastasis is the major diffusion route in rectal cancer,and jump metastasis is a very important characteristic. Survival rate of patients after operations will be influenced acutely if lymph nodes hadn't been resected thoroughly.It is reported that 50 percent of patients died of recurrence and metastasis after general radical resection of rectal carcinoma,and 20-30 percent of patients whose lymph nodes had been checked negatively by traditional pathology died in 5 years after operations.These results show that some micro remnant focuses of infection were left in these patients'bodies,we define them as micrometastasis.D3 lymph nodes are usually involved with micrometastasis,and these lymph nodes would be the potential dangers of recurrence after operations.To enlarge the lymph resection range to remove all the lymph nodes possiblly involved must conduce to decrease the rate of local recurrence and increase survival rate after operation. Studies of definite metastasis of lymph nodes in rectal cancer had been performed a lot while studies of micrometastasis few.Therefore,this study was desighed to explore the rule of D3 lymph nodes micrometastasis in rectal cancer to provide objective proofves for reasonable lymphadenectomy in recatal cancer.Method:Part one:â‘ 68 patients of mid-to-low rectal cancer in stage progression accepted the operations of laparoscopic D3 lamphadenectomy combined with PANP for rectal cancer.â‘¡After operation, dissolving the adipose tissue from the lymphatic tissue by xylene-ethanol technique to get all lymph nodes,every node be made into slices and stained with HE first,then negative ones would be stained immunohistochemical with the antibodies of CK20 and CDX2,results should be recorded.â‘¢To analyse the metastasis and micrometastasis situations of lymph node groups. Part two:â‘ Cutting a little part of the carcinoma,side carcinoma and normal tissue(at least 10 cm far from the margin of carcinoma) from the 68 patients in operations.â‘¡Cutting the three kind of tissues into slices and staining immunohistochemical with the antibody of VEGF-C along with the lymph nodes slices.â‘¢Analyse the relationship between VEGF-C expression and metastasis or micrometastasis of lymph node groups.RESULTS:â‘ All 676 D3 lymph nodes were detected by HE staining and immunohistochemical staining with CK20 and CDX2, 6 cases (14 nodes) were found to be with definite metastasis(8.8%), 12 cases (41 lymph nodes) be with micrometastasis (17.6%), and 5 found both.The total rate of D3 lymph nodes metastasis is 19.1%(13 cases).â‘¡VEGF-C expression is correlating with tumor staging,tumor typing,metastasis and micrometastasis of lymph node groups,but it has nothing to do with sex and age of patients. There is significant distinction in normal tissue,carcinoma and side carcinoma tissue.Distinction exists between no-metastasis-team and D1,D2,D3 lymph nodes metastasis teams,but not exist in the last three teams.â‘¢VEGF-C expression in shifted lymph nodes is obviously higher than in carcinoma tissue in patients suffered with rectal cancer, expression in D3 lymph nodes with micrometastasis and normal nodes are lower than in carcinoma tissue,but expressed similar between them.CONCLUSION:â‘ The definite metastasis rate of D3 lymph nodes in mid-to-low rectal cancer in stage progression is 8.8%,the micrometastasis rate is 17.6%,the total metastasis rate is 19.1%.â‘¡D3 lymph nodes metastasis happened not only secondum to mesenteric lymph nodes but also at the same timewith it. Therefore, whether mid-to-low rectal cancer in stage progression had been with mesenteric lymph nodes metastasis or not,D3 lymph nodes might happened.â‘¢The rate of D3 lymph nodes metastasis of mid-to-low rectal cancer of stage progression is quite high,and we can't determine whether D3 lymph nodes have been involved or not befor or in the process of operation,therefore,D3 lymphadenectomy is with great value for patients of mid-to-low rectal cancer in stage progression.