摘要目的 探讨胃、肠免疫表型标志物在早期胃印戒细胞癌中的表达及其与临床病理参数和预后的相关性.方法 免疫组织化学EnVision法检测91例早期胃印戒细胞癌中胃免疫表型标志物MUCI、MUCSAC、MUC6和肠免疫表型标志物MUC2、CDX2的表达,并根据肿瘤细胞胃、肠免疫表型标志物表达水平的差异,将早期胃印戒细胞癌分为3种类型:胃型、肠型和混合型.结果 胃型、混合型和肠型印戒细胞癌分别为53例(58.2%)、22例(24.2%)和16例(17.6%).胃、肠免疫表型标志物表达水平与印戒细胞癌形态学分型无相关性(P>0.05).两种肠免疫表型标志物MUC2和CDX2在早期黏膜下层浸润癌中阳性表达率均显著高于黏膜内癌,差异有统计学意义(均P<0.01).两种胃免疫表型标志物MUCSAC和MUC6在早期黏膜下层浸润癌中的阳性表达率分别为52.9%(18/34)和20.6%(7/34)均显著低于黏膜内癌91.2%(52/57)和31.6%(18/57),差异有统计学意义(P<0.01和P<0.05).在淋巴结转移阳性组和脉管浸润阳性组中,MUC2和CDX2的阳性表达率均明显高于无淋巴结转移组和无脉管浸润组,差异有统计学意义(P<0.05).随着肿瘤病变范围的扩大,CDX2阳性表达率明显增高,差异有统计学意义(P<0.05).肠型印戒细胞癌比胃型印戒细胞癌更多见于早期黏膜下层浸润癌且有更高的淋巴结转移率(P=0.000和P=0.003).生存分析显示,肠型和混合型印戒细胞癌5年生存率明显低于胃型印戒细胞癌(P<0.05).结论 肠型胃印戒细胞癌临床生物学行为和预后均较胃型印戒细胞癌差.胃、肠免疫表型标志物的胃印戒细胞癌分型有助于评估预后并有可能指导治疗.

abstractsObjective To study the expression of gastric and intestinal phenotypic markers in gastric signet-ring cell (SRC)carcinoma and the relationship with the clinicopathologic parameters and prognosis. Methods Immunohistochemical study was carried out in 91 cases of early-stage SRC carcinoma using MUC1,MUC5AC and MUC6 antibodies as the gastric phenotypic markers and MUC2 and CDX2 antibodies as the intestinal phenotypic markers. According to the expression of phenotypic markers,the tumors were classified into three different subgroups: gastric,intestinal and mixed. The findings were analyzed together with various clinical parameters and follow-up data. Results Amongst the 91 cases studied,S3 cases (58.2%)belonged to gastric type,22 cases (24.2%)mixed type and 16 cases (17. 6% )intestinal type. The positive rates of MUC2 and CDX2 in early submucosal carcinoma were significantly higher than those in mucosal carcinoma (P <0.01). On the other hand,the rates of MUC5AC and MUC6 expression in early submucosal carcinoma were significantly lower than those in mucosal carcinoma (P<0. 01 and P <0. 05). The rates of MUC2 and CDX2 expression in cases with lymph node metastasis and vascular invasion were significantly higher than those in cases without nodal or vascular involvement (P < 0. 05 ). The expression of CDX2 was also significantly higher in cases with larger tumor size (P<0. 05). Cases with intestinal phenotype more likely had invasion deeper than mucosal layer and carried higher chance of lymph node metastasis (P = 0. 000 and P = 0. 003). Intestinal and mixed types correlated with shortened five-year survival. Conclusions The intestinal type of SRC carcinoma is associated with poorer biologic behavior and prognosis,as compared with that of the gastric type. Classification on the basis of immunophenotypic markers may be useful in predicting prognosis and guiding treatment for patients with gastric SRC carcinoma.