CD56 CgA Syn在92例原发食管小细胞癌中的表达及临床意义和预后分析

  目的   探讨神经内分泌标志物突触素（synaptophysin，Syn）、神经细胞黏附分子56（neuronal cell adhesion molecules 56，CD56）、嗜铬粒蛋白A（chromogranin A，CgA）在92例食管小细胞癌（primary esophageal small cell carcinoma，PESC）中的表达，并分析其表达与患者临床病理特征和预后间关系。   方法   采用免疫组织化学法（immunohistochemisty，IHC）检测PESC中CD56、CgA、Syn分子表达；logistic回归分析其与患者临床病理特征关系；Kaplan-Meier法、Cox多因素回归法进行单因素和多因素生存分析；Log-rank法比较各组间生存曲线差异。   结果   食管下段癌组织中CgA阳性表达率高于食管中、上段（72.2% vs. 41.1% vs. 10.0%），且差异具有统计学意义（P=0.001）。CD56、CgA、Syn表达与患者性别（P=0.262，0.998，0.931）、年龄（P=0.250，0.998，0.703）、肿瘤浸润深度（P=0.253，0.997，0.061）、淋巴结有无转移（P=0.767，0.998，0.613）无关；N1、N0的PESC生存期差异无统计学意义（P=0.563）；PESC混合鳞癌（HR=2.58；95%CI:1.11~5.98）及CgA阳性表达PESC（HR=1.87；95%CI:1.02~3.43）预后优于单纯PESC及CgA阴性表达患者。   结论   CgA表达与PESC肿瘤部位有关；淋巴结有无转移不影响PESC患者预后；组织学类型及CgA表达是PESC患者预后独立影响因素。 

Expression of tissue neuronal cell adhesion molecule 56, chromogranin A,and synapto-physin and its relationship with clinicopathological features and prognosis in 92 Chi-nese patients with primary esophageal small cell carcinoma

Objective:To investigate the expression level of synaptophysin (Syn), tissue neuronal cell adhesion molecule 56 (CD56) and chromogranin A (CgA) in 92 primary esophageal small cell carcinoma (PESC) and to explore its repationship with clinicopathological features and clinical outcome. Methods:Immunohistochemical studies of CD56, CgA, and Syn were performed in 92 paraffin-embed-ded tissues with clinical-related information obtained from 500,000 esophageal and gastric cardia carcinoma databases established by Henan Key Laboratory for Esophageal Cancer Research of the First Affiliated Hospital of Zhengzhou University in Henan, China. Binary logistic regression was used to analyze the correlations of CgA, Syn, and CD56 expression with clinicopathological features. Kaplan-Mei-er survival analysis and Cox proportional hazards regression models were performed for univariate and multivariate survival analyses. Log-rank test was used to compare the difference in survival rates. Results:The CgA-positive expression rate in PESC at lower segment of esophagus (72.2%) was higher than those at the middle and lower segments (41.1%, 10.0%) (P=0.001). The expression level of CD56, CgA, and Syn was not correlated with gender (P=0.262, 0.998, 0.931), age (P=0.250, 0.998, 0.703), tumor invasion (P=0.253, 0.997, 0.061), and lymph node metastasis (P=0.767, 0.998, 0.613). Univariate analysis showed no survival influence in patients with and without lymph node metastasis (P=0.563). Multivariate survival analysis showed that patients with PESC mixed squamous cell car-cinoma (HR=2.58;95%Cl, 1.11-5.98) and higher CgA protein expression (HR=1.87;95%Cl, 1.02-3.43) exhibited a longer survival time than those with pure PESC and without CgA expression. Conclusion:Tissue CgA level was associated with tumor location in PESC. His-tological type and tissue CgA expression were independent important prognostic factors, and lymph node metastasis exerted no influ-ence on survival in PESC.