胃腺癌临床病理及相关基因与预后

 【摘要】　目的　进一步探索影响胃癌患者生存因素的有用指标。方法　采用流式细胞仪（FCM）和免疫组织化学（IHC）技术分别检测98例胃腺癌P- 糖蛋白（P-gp）、CD44、CD25和C-erbB-2、p16、p53抗体表达水平,并结合临床病理和随访资料进行相关性分析。结果　以随访3年内死亡60例（其中失访11例按死亡计）为死亡组,生存3年以上38例（38.3 %）为生存组。死亡组临床Ⅰ～Ⅱ期5例,Ⅲ～Ⅳ期55例;淋巴结无转移3例,转移57例;无瘤栓或累及神经21例,有瘤栓或累及神经39例;无浆膜浸润6例,有浆膜浸润54例。与相应生存组比较分别为21、17例;17、21例;26、12例;12、26例。均显示差异有统计学意义（P＜0.01）;死亡组肿瘤组织学分级中分化9例,低分化51例;瘤体≤5 cm 18例,＞5 cm 42例;肿瘤1个部位累及16例,2～3个部位累及44例;血型A 10例,O 31例与相应生存组比较分别为14、24例;21、17例;18、20例;14、13例,均显示差异有统计学意义（P＜0.05）。而胃癌相关基因C-erbB-2、p16、p53、P-gp、CD44、CD25的表达在两组间比较均显示差异无统计学意义。结论　胃癌患者临床分期、淋巴结转移、瘤体及神经受侵、浆膜浸润、瘤细胞分化程度、瘤体大小和累及范围是影响患者生存的重要因素。胃癌相关基因表达的确切意义和作用尚有待更多资料的研究。

Clinicopathological and related gene analysis in gastric adenocarcinoma and their correlation with prognosis

【Abstract】　Objective　To investigate the useful predictor of survival for patients with gastric adeno－carcinoma. Methods　The expression of P-glycoprotein(P-gp), CD44, CD25 and C-erbB-2, p16 and p53 were evaluated and analyzed in 98 cases of gastric adenocarcinoma, using flow cytometry and immunohistochemical stains(IHC), to determine their prognostic impact on patients' survival. Results　Sixty cases that died within 3 years were divided into death group, 38 cases that survived over 3 years were divided into survival group. The patients of death group were more liable to manifest clinical stage Ⅲ－Ⅳ(55/60), lymph node metastasis(57/60), lymphatic tumor emboli and/or neural involvement(39/60), serosa infiltration(54/60), poorly differentia－tion(51/60), ＞5cm in volume(42/60), multiple site involvement(44/60), blood type "O" (31/41), in comparison with those of survival group, and the difference was statistically significant. C-erbB-2, p16, p53, P-gp, CD44 and CD25 expression were not significantly different in these two groups. Conclusion　The clinical stage, lymph node metastasis, lymphatic tumor emboli and/or neural involvement, infiltration depth, histological dif－ferentiation, tumor volume, involvement extension are important prognostic factors in patients with gastric can－cer, while the significance of cancer-related gene expression in gastric carcinomas needs to be studied further.