摘要目的 评估细胞角蛋白(CK)7、CK8/18、CK19和p40在食管鳞状细胞癌(简称鳞癌)中的表达及其与预后的关系.方法 收集郑州大学第一附属医院2012年间手术切除并经病理确诊的食管鳞癌190例,其中男性116例,女性74例;年龄28～82(60.3±8.6)岁,<60岁88例,≥60岁102例.同时选取154例癌旁正常食管黏膜作为对照.采用免疫组织化学SP法检测食管鳞癌、正常食管组织中CK7、CK8/18、CK19和p40的表达情况,并分析CK7、CK8/18、CK19和p40在食管鳞癌中表达的意义、与临床病理参数之间的关系以及对患者预后的影响等.结果 在190例食管鳞癌中,p40和CK19均有表达,其中高表达者(弥漫阳性)分别为77.4％(147/190)、79.5％(151/190),低表达者(局部/斑片状)分别为22.6％(43/190)、20.5％(39/190);二者的表达水平均与淋巴结转移和pTNM分期显著相关(P<0.05);其中CK19低表达者较高表达者预后差(P<0.01),但p40表达水平与预后无关(P>0.05).CK7和CK8/18可在部分食管鳞癌中表达,阳性率分别为15.3％(29/190)、31.1％(59/190),二者阳性率均与肿瘤分化程度和淋巴结转移显著相关,且阳性表达者较阴性表达者预后差(P<0.05).进行多因素生存分析后发现,除pTNM分期外,CK19的低表达和CK8/18的阳性表达是影响患者预后的独立危险因素.结论 在低分化食管上皮源性肿瘤中,p40的低表达和CK7、CK8/18的阳性表达并不能除外鳞癌的诊断;食管鳞癌中p40、CK19的低表达和CK7、CK8/18的阳性表达提示患者易发生淋巴结转移,且预后差;CK19的低表达和CK8/18的阳性表达是影响食管鳞癌患者预后的独立危险因素.

abstractsObjective To evaluate the expression of cytokeratin ( CK) 7, CK8/18,CK19 and p40 in esophageal squamous cell carcinoma ( ESCC) and its significances. Methods One hundred and ninety cases of surgically resected ESCCs and 154 normal esophageal tissues as control were collected at the First Affiliated Hospital of Zhengzhou University in 2012. Of the 190 ESCC cases including 116 male and 74 female, aged 28-82 (60. 3±8. 6) years, 88 cases <60 years old and 102 cases ≥60 years old. Tissue sections were immunostained for CK7, CK8/18, CK19 and p40, and the expression was evaluated and correlated with the clinicopathologic findings and outcome. Results CK19 and p40 were expressed in 190 cases of ESCCs;with 147 cases ( 77. 4％) and 151 cases ( 79. 5％) showing high p40 and CK19 expression, respectively;while 43 cases ( 22. 6％) and 39 cases ( 20. 5％) showed low p40 and CK19 expression, respectively. The low expression groups showed more lymph node metastases and higher pTNM stages compared to the high expression groups. The high CK19 expression group showed better prognosis than the low expression group ( P<0. 01);p40 expression was not correlated with prognosis( P>0. 05) . In contrast,CK7 and CK8/18 expression was only seen in 29 cases ( 15. 3％) and 59 cases ( 31. 1％) of ESCCs, respectively, and their expression correlated significantly with the degree of tumor differentiation and lymph node metastasis ( P<0. 05 ) . The prognosis in the CK7 negative group was better than that in the CK7 positive group. Similar results were found in CK8/18 expression. Multivariate analysis revealed that pTNM stages, low CK19 expression and CK8/18 expression were independent prognostic factors. Conclusions Low p40 expression and the expression of CK7 and CK8/18 cannot exclude poorly-differentiated ESCCs. CK7 and CK8/18 expression and low CK19 and p40 expression in the ESCCs are associated with lymph node metastasis and poor prognosis. Decreased expression of CK19 and positive expression of CK8/18 in ESCCs are independent prognostic markers.