食管癌明胶酶A基因表达及其与转移关系的研究

向周围组织浸润是恶性肿瘤的典型特征,对细胞外基质的溶解是肿瘤细胞向外扩散的基础。近来的研究表明基质金属蛋白酶(matrix metalloproteinases,MMPs)在肿瘤溶解细胞外基质向外侵袭中发挥了重要作用。明胶酶A(gelatinaseA,MMP2)是基质金属蛋白酶的一种,它在乳腺癌、前列腺癌及结肠癌中的研究已有报道[1,2]。我们用逆转录定量PCR方法研究了食管癌患者明胶酶A基因表达的情况,现报道如下。     

Expression of human chorionic gonadotropin, CD44v6 and CD44v4/5 in esophageal squamous cell carcinoma

AIM: To study the relationship between the expression of human chorionic gonadotropin (HCG), CD44v6, CD44v4/5 and the infiltration, metastasis of esophageal squamous cell carcinoma. METHODS: By labeled streptavidin-biotin technique, the expressions of HCG, CD44v6, and CD44v4/5 in 42 patients with esophageal squamous cell carcinoma were examined. RESULTS: The positive rate of HCG expression in patients with lymph node metastasis was 85.71% (18/21), higher than that (57.14%, 12/21) in those without lymph node metastasis (P<0.05). The positive rate of CD44v6 expression was 71.43% (15/21) in lymph node metastasis group, and 38.09% (8/21) in non-metastasis group; there was a significant difference between the two groups (P<0.05). The positive rate of CD44v4/5 expression was 76.19% (16/21) in lymph node metastasis group, and 42.86% (9/21) in non-metastasis group; there was also a significant difference between them (P<0.05). From grade Ⅰ to grade Ⅲ in differentiation, the positive rate of HCG expression was 84.62% (11/13), 70.59% (12/17) and 58.33% (7/12), respectively; there was no significant difference among them (P<0.05). The positive rate of CD44v6 expression in grades Ⅰ-Ⅲ of cancer tissues was 76.92% (10/13), 52.94% (9/17), and 33.33% (4/12) respectively; there was no significant difference among them. The positive rate of CD44v4/5 expression in grades Ⅰ-Ⅲ of cancer tissues was 69.23% (9/13), 64.71% (11/17), and 41.67% (5/12) respectively; there was no significant difference among the three groups. There was no correlation between the positive rates of HCG and CD44v6, CD44v4/5 expression. Cancer cells in carcinomatous emboli and those infiltrating into vascular wall strongly expressed HCG, CD44v6, and CD44v4/5. CONCLUSION: Expression of HCG, CD44v6, and CD44v4/5 in esophageal squamous cell carcinoma is related to its infiltration and metastasis. HCG, CD44v6, and CD44v4/5 have different effects on the infiltration and metastasis of esophageal squamous cell carcinoma.     

Epidemiological investigation of esophageal carcinoma

AIM: To review the characteristics of esophageal carcinoma in recent 30 years in the epidemiological investigation. METHODS: A total of 1 520 cases of esophageal carcinoma in the First Affiliated Hospital of Zhejiang University Medical College admitted from 1970 until now were reviewed. Their age, gender, position of carcinoma and histological type were analyzed. RESULTS: The morbidity of esophageal carcinoma was increasing during the observation period. Compared with the 1970s (9.5%), the ratio of adenocarcinoma significantly increased after the 1980s (19.1%). The difference was significant (P≤0.05). CONCLUSION: The morbidity of esophageal adenocarcinoma was increasing and advanced clinical study should be strengthened.     

河南食管癌高发区ABO血型及血细胞分类记数与食管癌和贲门癌关系研究

目的 通过分析河南辉县食管癌高发区食管癌和贲门癌患者ABO血型分布以及全血细胞的变化特征，进一步了解这些变化与食管癌和贲门癌的关系。方法 统计辉县市人民医院17年间(1987～2003)食管和贲门癌收治记录，分析比较食管和贲门癌患者各血型的分布情况以及各种血细胞数量的差异。结果 食管癌患者中，男女均为B型血比例最高，分别占38．6％和34．7％；贲门癌男性患者中，O型血所占比例最高(39．6％)；贲门癌女性患者中，B型血(46．7％)所占比例远高于其它血型；而AB血型的人在食管和贲门癌中所占的比例都最低(7．7％vs13．2％)。食管癌及贲门癌患者均出现不同程度的全血细胞降低改变，贲门癌患者红细胞降低最明显(男：50％，女：56％)，类似的情况还见于血红蛋白。贲门癌患者淋巴细胞降低的检出率高于食管癌患者。贲门癌患者贫血和淋巴细胞降低明显，其临床意义尚待进一步研究。结论 B型血患食管癌的风险较大，O型血的男性和B型血的女性息贲门癌的风险较大，而AB型息食管癌和贲门癌的风险均较低。而外周血各项常规指标的变化与食管癌和贲门癌的关系还有待于进一步研究。     

食管癌防治的新策略

目的：寻找降低食管癌高发区食管癌发病率和死亡率的有效方法。方法：对重度不典型增生的人群根据病理学、细胞学和γ-GT反应的不同进行了三年的研究。结果：γ-GT阴性反应者和40岁以下伴γ-GT阳性的患者未发生癌变，γ-GT阳性伴重增I级患者的癌变率为5.7%，而γ-GT阳性伴重增Ⅱ级患者的癌变率为14.3%，结论：食管癌高发区的预防应以γ-GT转阴而定。在食管癌预防中应将重增患者依据γ-GT反应进行分类，仅对γ-GT阳性伴重增的患者进行干预，可明显提高食管癌防治中的效价比。此方法简单且符合中国国情。     

保留胃左血管的食管癌切除术20例报告

食管癌切除胃代食管胸腔内吻合是临床常用术式 ,虽然吻合技术、缝合方法不断改进 ,但不时仍有吻合口瘘的发生。近年来 ,笔者施行保留胃左血管的食管癌切除术 2 0例 ,临床效果较好。现报告如下。一般资料 :本组男 19例 ,女 1例 ;年龄 76～ 40岁 ,平均 63岁 ,70岁以上 5例。均有吞咽困难症状 ,经上消化道钡餐造影及食管镜检查诊断为食管下段病变。肿瘤下端距贲门 5 . 0 cm左右 ,肿瘤直径 3 . 0～ 6. 0 cm,平均 4. 4cm。合并高血压病 11例 ,冠心病 9例 ,中度肺功能障碍 8例 ,糖尿病 5例 ,脑中风后遗症 1例。手术方法 :经左胸第 6肋间或第 7肋骨…     

自膨式金属支架治疗晚期食管癌梗阻及食管支气管瘘

目的探讨内镜结合X线透视下放置自膨式金属支架对晚期食管癌吞咽困难及食管气管瘘的疗效。方法30例晚期食管癌和5例并发食管支气管瘘的恶性狭窄患者，在内镜直视及X线透视下放入导丝而后用探条逐级扩张食管后放入自膨式金属支架，并发食管瘘者放置带膜支架。结果30例患者放置金属支架一次成功率为100％，5例并发食管支气管瘘者均瘘口一次性封H（5／5，100％），1例术后少量出血．1例术后1月支架滑脱，少数病例出现轻微胸痛，无严重并发症出现。结论内镜直视结合X线透视下放置自膨式金属支架治疗晚期食管癌梗阻及食管支气管瘘是一种安全、有效、易行的方法。     

食管癌根治术后及术后辅助放疗192例分析

目的 探讨食管癌根治术后辅助放疗以及影响预后的因素。方法 行根治术食管癌192例(病理分期为Ⅰ期6例，Ⅱa期104例，Ⅱb期46例，Ⅲ期36例)，其中44例合并术后辅助性放射治疗。结果 192例食管癌根治术后患者5年总的生存率为29．5％．1、3、5年总的生存率单手术组(72％、39．5％、29．1％)与术后放疗组(77．4％、40．8％、29．5％)统计学无明显差异（P=0．993)。Ⅰ Ⅱa期l、3和5年总生存率分别为82．5％、50．8％和41．0％，Ⅱb期分别为63．5％、26．8％和13．4％，Ⅲ期为56％、19．6％和9．8％，有统计学意义(P=0．0002)。胸上段食管癌l、3、5年生存率分别为100％、67．4％和44．9％，胸中段分别为72．5％、37．0％和29．2％。胸下段分别为70．0％、40．2％和27．8％，统计学无差异(P=0.51)。结论 食管癌根治术后辅助放疗对生存率的作用不太明显，应慎重实施；分期是影响食管癌预后的主要因素。     

Relationship between Egr—1 gene expression and apoptosis in esophageal carcinoma and precancerous lesions

AIM: To study the expression of early growth response gene-1 (Egr-1 gene) and Bcl-X/(L) protein and its relationship with the cell apoptosis in human esophageal carcinoma (EC) and precancerous lesions. METHODS: In situ hybridization(ISH), immunohistochemistry (IHC) and TUNEL method were used respectively to detect Egr-1mRNA, Egr-1 protein, apoptosis related-protein Bcl-X/(L) and cell apoptosis in situ from 66 cases of esophageal squamous cell carcinoma and their upper cut edge and paracancerous mucosa. RESULTS: Egr-1 gene in situ hybridization, Bcl-X/(L) immunohistochemistry positive products were located in the cytoplasm, while Egr-1 immunohistochemistry and TUNEL positive signal were located in the nuclei. The apoptosis index(AI) and the frequency of apoptosis occurrence were increased gradually from precancerous lesion to cancer (P<0.01) and the expression of Egr-1mRNA and Egr-1 protein in dysplasia was the highest among all specimens (P<0.01). The AI of Egr-1 positive cancer tissues was much higher than that of Egr-1 negative cancer tissues (P<0.01), while the AI of Bcl-X/(L) positive cancer tissues was much lower than that of Bcl-X/(L) negative cancer tissues (P<0.01). The AI and Egr-1 expression were not correlated with invasiveness and lymphatic metastasis in EC. CONCLUSION: Cell apoptosis was present through esophageal carcinogenesis. The expression of Egr-1 mRNA and Egr-1 protein were high in precancerous lesion of esophagus. The AI was increased significantly in Egr-1 positive squamous cell carcinoma. Egr-1 might promote apoptotic effect. Egr-1 expression and cell apoptosis may have an important biological significance in esophageal carcinogenesis.     

食管癌组织微卫星DNA序列不稳定性和杂合性缺失及预后的研究

目的探讨微卫星DNA序列不稳定性（MSI）和杂合性缺失（LOH）与人食管癌发生、临床病理特征及预后的关系。方法应用聚合酶链反应（PCR）和变性聚丙烯酰胺凝胶电泳技术,对30例人食管癌中MSI及LOH阳性情况进行研究,术后随访5年,了解预后。结果D3S1067位点MSI发生检出频率较高,为26.7%;D18S58位点MSI阳性率为20%。MSI的发生在食管小细胞癌中较食管鳞癌为高（P〉0.05）;MSI、LOH与肿瘤的病理分级、PTNM分期、有无区域淋巴结转移和浸润深度无关（P〉0.05）。结论食管癌在3p和18q染色体位点均存在微卫星不稳定现象;D3S1067和D18S58二个位点上MSI与食管癌的临床病理类型均相关;研究未发现这两个位点MSI、LOH与食管癌的临床分期、细胞分化程度、癌组织浸润深度和有无区域淋巴结转移等参数相关;3p位点基因的改变在食管鳞癌发生过程中具有较重要意义。