IPCL分型联合Cyclin D1、PDGFR对食管早期肿瘤的诊断和预后预测价值

目的探讨食管上皮乳头内毛细血管袢（intrapapillary capillary loop，IPCL）分型联合细胞周期素D1（Cyclin D1）、血小板衍生生长因子受体（platelet derived growth factor，PDGFR）对食管癌的诊断和预后预测价值。 方法收治经NBI-ME检查的食管浅表型病变患者118例（病变118处），对食管癌组织进行IPCL分型和病理分级，检测食管癌组织Cyclin D1、PDGFR的表达，并于术后随访5年，记录患者生存期。 结果食管癌浅表型病变IPLC分型Ⅲ型、Ⅳ型以食管炎、LGIN为主；V1型、V2型、V3A型以早期食管癌为主，诊断早期食管癌的敏感度、特异度、阳性预测值、阴性预测值分别为85.5%（71/83）、80.0%（28/35）、91.0%（71/78）、83.9%（28/40）；V3B型、VN型以SM1、SM2及以深食管癌为主，诊断SM2及以深食管癌的敏感度、特异度、阳性预测值、阴性预测值分别为70.0%（7/10）、92.6%（100/108）、46.7%（7/15）、90.7%（100/103）。早期食管癌、SM1、SM2及以深食管癌患者Cyclin D1、PDGFR表达程度显著高于食管炎、LGIN患者（P＜0.01）。强阳性表达Cyclin D1（P=0.036）、PDGFR（P=0.034）的早期食管癌患者5年生存率显著低于阳性或弱阳性或阴性表达患者。早期食管癌IPCL分型、Cyclin D1及PDGFR的表达均为早期食管癌预后的独立危险因素。 结论IPCL分型对于食管早期肿瘤诊断具有一定的指导意义，检测食管癌组织Cyclin D1、PDGFR表达有助于早期食管癌的预后判断，IPCL分型、Cyclin D1及PDGFR的表达均为早期食管癌预后的独立危险因素。

The predictive value of IPCL typing combined with Cyclin D1 and PDGFR in the diagnosis and prognosis of early esophageal cancer

ObjectiveTo explore the predictive value of intrapapillary capillary loop(IPCL) typing combined with Cyclin D1 and platelet-derived growth factor receptor(PDGFR) in the diagnosis and prognosis of esophageal cancer.MethodsA total of 118 patients with superficial esophageal lesions(118 lesions) examined by NBI-ME were enrolled in this study.The esophageal cancer tissues were classified based on IPCL typing and pathological typing, and Cyclin D1 and PDGFR expression in esophageal cancer tissues were detected. They were followed-up for 5 years after operation, and patient survival was recorded.ResultsBased on ICT typing of esophageal cancer with superficial esophageal lesions, type Ⅲ and type Ⅳ were mainly esophagitis and LGIN. Type V1, type V2 and type V3A were mainly early esophageal cancer(EEC), and the sensitivity, specificity, positive predictive value(PPV) and negative predictive value(NPV)in the diagnosis of EEC were 85.5%(71/83), 80.0%(28/35), 91.0%(71/78), and 83.9%(28/40), respectively. Type V3B and type VN were mainly SM1, SM2, and lower segment esophageal cancer. The sensitivity, specificity, PPV and NPV in the diagnosis of SM2 and lower segment esophageal cancer were 70.0%(7/10), 92.6%(100/108), 46.7%(7/15) and 90.7%(100/103), respectively. The expression of Cyclin D1 and PDGFR in patients with EEC, SM1, SM2 and lower segment esophageal cancer was significantly higher than that in patients with esophagitis and LGIN(P＜0.01). The 5-year survival rate of EEC patients with strong positive expression of Cyclin D1(P=0.036) and PDGFR(P=0.034) was significantly lower than that of patients with positive, weak positive or weak negative expression. IPCL typing, expression of Cyclin D1 and PDGFR in EEC were independent risk factors for the prognosis of EEC.ConclusionIPCL typing has certain guiding significance for the diagnosis of EEC. Detection of Cyclin D1 and PDGFR expression in esophageal cancer tissues is conductive to the prognosis of EEC. IPCL typing, and expression of Cyclin D1 and PDGFR are the independent risk factors for the prognosis of EEC.