Immunhistologischer Nachweis disseminierter Tumorzellen in Lymphknoten beim Pankreaskarzinom: Häufigkeit und prognostische Bedeutung

Zusammenfassung.

Die Prognose des Pankreaskarzinoms ist trotz radikal-chirurgischen Vorgehens durch das Auftreten eines Lokalrezidivs oder Metastasierung unverändert schlecht. Die Infiltration in regionale Lymphknoten ist mit einer signifikanten Verkürzung der Überlebenszeit verbunden. Ziel der Studie ist es, die Häufigkeit einer frühen Tumorzelldissemination in konventionell-histopathologisch als tumorfrei beurteilte Lymphknoten zum Operationszeitpunkt mit Hilfe immunhistologischer Methodik zu sichern.

25 Patienten mit einem Adenokarzinom des Pankreas (15 duktale Pankreaskopf- und 10 Papillenkarzinome) wurden chirurgisch radikal reseziert. Alle Patienten hatten ein Tumorstadium pT_xpN₀M₀. 229 histopathologisch tumorfreie Lymphknoten wurden auf disseminierte Tumorzellen untersucht. Der Nachweis erfolgt mit dem Zytokeratinantikörper AE1/AE3. Zur Prüfung der Methode wurden weitere 81 Lymphknoten von Patienten mit einer chronischen Pankreatitis analysiert. 55 von 229 Lymphknoten (26,3 %) wiesen disseminierte Tumorzellen auf. Alle Patienten (100 %) mit einem duktalen Pankreaskopfkarzinom hatten in mindestens einem Lymphknoten Tumorzellen. Beim Papillenkarzinom gelang in keinem Fall der Nachweis disseminierter Tumorzellen. Ebenso fand sich in der Kontrollgruppe kein falschpositiver Befund. Die schlechte Prognose des duktalen Pankreaskarzinoms gegenüber dem Papillenkarzinom (mediane Überlebenszeit 14,0 vs. 48,0 Monate) könnte auf die frühe Tumorzelldissemination in Lymphknoten zurückzuführen sein. Diese lymphogene Metastasierung bereits im niedrigen Tumorstadium pT_{1 - 3}N₀M₀ führt zur Forderung, den Stellenwert einer adjuvanten Therapie bei allen Patienten mit einem Pankreaskarzinom zu prüfen.

Immunhistochemical detection of disseminated tumor cells in lymph nodes in early pancreatic carcinoma: frequency and prognostic significance.

Outcome of surgical treatment of pancreatic carcinomas is often limited due to local recurrence and, in particular, due to the development of metastases. Tumor infiltration of regional lymph nodes is closely associated with a reduced life exspectancy. The aim of the study was to determine frequency and prognostic relevance of the micrometastatic tumor cells detectable by immunhistochemistry in lymph nodes of patients with totally resected pancreatic carcinoma (R0 resection). In total, 229 lymph nodes were classified as tumor-free with routine histopathology in 25 patients (15 patients with ductal carcinoma of the head of the pancreas, 10 patients with carcinoma of the papilla of Vater). In addition, samples were investigated for the presence of disseminated tumor cells with immunhistochemistry using antiepithelial monoclonal antibody AE1/AE3. In 55 of 229 lymph nodes (26.3 %), AE1/AE3-positive tumor cells were detected. In all patients with ductal carcinoma of the head of the pancreas (100 %), there were tumor cells detectable in minimally one lymph node. No disseminated tumor cells were found in each patient with carcinoma of the papilla of Vater. As a control, 81 lymph nodes from patients (n = 11) with chronic pancreatitis were stained. In this control group no false positive results were found. Prognostic differences between patients with ductal pancreatic carcinoma compared with carcinoma of the papilla of Vater (median survival time, 14.0 vs. 48.0 months, resp.) may be caused by the early dissemination of tumor cells into lymph nodes. The detection of early lymphogenic micrometastases in initial tumor stages (T_{1 - 3} N₀ M₀ ) may suggest that adjuvant treatment regimens have to be proven in all patients with pancreatic carcinoma.

Pankreaskarzinom - Papillenkarzinom - Prognose - Chirurgie - disseminierte Tumorzellen - Tumorzelldetektion

Pancreatic carcinoma - Carcinoma of the papilla of Vater - Surgery - Prognosis - Lymph nodes - Isolated disseminated tumor cells - Tumor cell detection

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