乙酰肝素酶在胃癌组织中的表达及其与临床病理特征的关系

目的 探讨乙酰肝素酶在胃癌组织中的表达及其与临床病理特征的关系.方法 应用免疫组化方法检测60例胃癌术后组织标本及正常组织中乙酰肝素酶的表达,分析乙酰肝素酶表达与胃癌临床病理特征的关系.结果 胃癌组织中存在乙酰肝素酶蛋白的表达,并定位于肿瘤细胞质中.60例胃癌组织中有40例乙酰肝素酶表达阳性(40/60,66.7％),正常组织有1例表达阳性(1/10,10％),两组间差异显著(P ＜0.05).乙酰肝素酶蛋白在胃癌中的表达与患者性别、年龄、肿瘤直径无关(P＞0.05),与组织学分级、TNM分期、淋巴结转移相关(P＜0.05).结论 乙酰肝素酶在胃癌中高表达,与胃癌进展程度和恶性行为相关,对胃癌的发生、发展起促进作用,可为临床治疗和诊断提供一定依据.     

乙酰肝素酶在胃癌组织中的表达及临床意义

癌细胞侵袭和转移的一个重要机制是降解基底膜和细胞外基质结构.硫酸乙酰肝素降解性糖苷内切酶的激活与肿瘤细胞转移有关,这在鼠B16-Fl0黑色素瘤细胞在血管内皮细胞细胞外基质上的培养试验中被证实[1].Takaoka等[2]采用逆转录聚合酶链反应(RT-PCR)和免疫组化方法在临床标本和细胞中证明乙酰肝素酶的表达与胃癌的侵袭性和预后不良有关.     

乙酰肝素酶在大肠癌中的表达及意义

目的探讨大肠癌组织中乙酰肝素酶（Hpa）的表达,及其与大肠癌发生、浸润、转移及预后的关系。方法采用免疫组化Envison法测定大肠癌的癌组织与正常大肠组织中Hpa蛋白表达,结合大肠癌的临床病理学特征及预后进行分析。结果 Hpa蛋白在大肠癌组织中的表达高于正常组织（P〈0.01）。Hpa蛋白在大肠癌无淋巴结转移者的表达低于有淋巴结转移者,Ⅰ、Ⅱ期低于Ⅲ、Ⅳ期,生存时间小于5 a者低于高于5 a者（P均〈0.01）。结论 Hpa在大肠癌组织中高表达,其可能在大肠癌的发生、侵袭和转移中起作用。     

肝癌组织乙酰肝素酶的表达及其与微血管密度的关系

目的观察乙酰肝素酶（Hpa）在肝癌组织中的表达,并探讨其与微血管密度（MVD）的关系。方法采用RT-PCR法检测47例原发性肝癌组织、癌旁组织1（A组）和癌旁组织2（B组）Hpa mRNA水平;采用免疫组织化学法检测肝癌组织Hpa蛋白和CD34表达水平,并分析Hpa蛋白与肝癌临床病理特征的关系,以及Hpa mRNA水平与MVD值的相关性。结果在不同直径和分化程度、不同临床分期、是否转移复发、AFP水平和有无门脉癌栓等肿瘤组织,Hpa蛋白表达存在明显的差异（P<0.05）;肝癌组织Hpa mRNA水平（0.793±0.184）和MVD值（34.5±12.2）均明显高于A组和B组（P<0.05）,而A组Hpa mRNA水平（0.577±0.145）和MVD值（22.2±10.7）又明显高于B组[（0.384±0.117）和（14.7±7.4）,P<0.05];各组Hpa mRNA水平与MVD值呈正相关（r=0.627,P<0.05）。结论Hpa在肝癌的生长、侵袭和血管生成中发挥着重要作用。     

声门上型喉癌中乙酰肝素酶的表达及意义

目的探讨乙酰肝素酶(HPA)在声门上型喉癌组织中的表达及其临床意义。方法应用免疫组化技术检测HPA蛋白在60例声门上型喉癌组织和癌旁组织、10例正常喉组织中的表达情况。结果60例癌组织中,27例(45.0%)HPA蛋白阳性表达,癌旁组织中仅3例(5.0%)阳性表达,10例正常喉组织均为阴性表达。HPA蛋白的表达与TNM分期、颈淋巴结转移率、复发率及5a生存率有关(P<0.05)。结论声门上型喉癌组织中HPA蛋白高表达,并与肿瘤的侵袭转移、复发、预后有关。     

乙酰肝素酶与动脉粥样硬化

动脉粥样硬化是致死率较高的常见心血管疾病,乙酰肝素酶是能够裂解细胞外膜中硫酸乙酰蛋白多糖上侧链乙酰肝素的一种内切性β-D-葡萄糖醛酸糖苷酶,且其非酶活性也在许多正常生理活动或病理疾病中发挥作用。研究表明乙酰肝素酶与动脉粥样硬化的形成和进展有着紧密的联系。本文综述了乙酰肝素酶损伤内皮、促凝、诱导炎症因子及脂质聚集等作用,并阐述其在动脉粥样硬化发生发展中的作用及机制。     

乙酰肝素酶与糖尿病肾病

乙酰肝素酶(HPSE)是一种能降解硫酸乙酰肝素(HS)的内-β-D-葡糖醛酸苷酶.因其可促进肿瘤转移和血管生成而受到肿瘤研究领域广泛关注.最近研究提示HPSE与糖尿病肾病(DN)蛋白尿的发生关系密切[1].现将HPSE与DN之间的研究进展作一综述.     

乙酰肝素酶在肿瘤侵袭转移和血管生成中的作用

侵袭和转移是肿瘤重要的生物学特征，而细胞外基质(extracenular matrix，ECM)的降解和新生血管的形成则是促进肿瘤侵袭转移的关键因素。乙酰肝素酶(heparanase，HJPSE)是新近克隆出来的一种基质降解酶，可降解ECM和基底膜(basement membrance，BM)中的硫酸乙酰肝素(heparan sulfate，HS)，在肿瘤细胞的侵袭转移和血管生成过程中发挥着重要作用。     

原发性肝癌组织芯片中乙酰肝素酶的表达及意义

目的:探讨乙酰肝素酶(heparanase,HPA)蛋白在原发性肝细胞癌(HCC)组织芯片中的过度表达及临床意义.方法:125例HCC患者肝组织、48例肝癌患者癌旁组织、62例肝硬化患者肝组织及23例肝血管瘤患者相应正常肝组织构建组织微阵列.应用免疫组织化学检测HPA蛋白的表达水平,并分析其与HCC临床病理特征的关系.结果:HCC组织中的HPA蛋白的阳性率45.83%明显高于癌旁组织27.08%(x~2=2.23,P<0.05),肝硬化6.45%(x~2=5.262,P<0.05)和正常肝组织4.35%(x~2=3.895,P<0.05).癌旁组织中的HPA蛋白阳性率明显高于肝硬化(x~2=2.882,P<0.05)及正常肝组织(x~2=2.361,P<0.05);HCC中临床TNM分期ⅠⅡ期HPA阳性率明显低于ⅢⅣ期(29.41% vs 67.31%,x~2 =4.111,P<0.05);HCC中无转移组HPA阳性率明显低于转移组(14.71% vs 63.33%,x~2= 3.978,P<0.05);HPA表达率在AFP≥400μg/L和AFP<400μg/L组(52.05% vs 36.17%,x~2= 2.071,P<0.05)、有无门脉癌栓组(71.74% vs 29.73%,x~2=4.472,P<0.05)、多个和单个肿瘤结节组(73.91% vs 28.38%,x~2=4.847,P<0.05)以及肿瘤直径≥5 cm和<5 cm组(57.89% vs 25%,x~2=3.471,P<0.01)分别具有显著性意义.HPA表达与年龄、性别、分化程度、有无肝硬化及肿瘤包膜浸润无关.结论:HPA高表达在HCC的发生、发展及转移中起重要作用.检测HPA蛋白指标有助于HCC诊断和判断患者预后.     

富含半胱氨酸的酸性分泌蛋白在人大肠癌、大肠腺瘤的表达及其临床意义

[目的]探讨富含半胱氨酸的酸性分泌蛋白(SPARC)在人大肠癌、大肠腺瘤中的表达及其临床意义。[方法]采用免疫组化SABC法检测65例人大肠癌、32例人大肠腺瘤及29例正常人大肠组织中SPARC的表达。[结果]免疫组化结果显示SPARC在人大肠腺癌细胞及间质细胞均有不同程度表达。大肠癌、大肠腺瘤及正常组织三者之间比较,SPARC在组织腺管细胞中的阳性表达率差异无统计学意义(P0.05),而在间质细胞中的表达率差异显著(P0.05)。另外,在人大肠癌间质细胞中,SPARC的阳性表达率与癌组织分化程度、淋巴结转移与否呈明显相关性(P0.05),而与患者性别、年龄、肿瘤部位无关(P0.05)。[结论]SPARC有可能作为评估大肠肿瘤浸润转移及其预后的生物学指标,为进一步研究大肠肿瘤的早期筛查与诊断提供了新的思路与方法。     

生长抑素受体表达与肝细胞癌病理特征及预后的关系

目的研究生长抑素受体(SSTR)在肝细胞癌组织中表达水平及其与肝细胞癌临床病理特征及预后的关系。方法所有肝细胞癌标本取自2012年7月-2014年12月就诊于解放军第三医院及大连医科大学附属二院肝胆科行切除术后经病理组织学检查证实为HCC的患者(n=80,试验组),另选取同期疑似肝部疾病且行肝穿刺确诊的非肝细胞癌患者(n=80,对照组)。采用RT-PCR检测SSTR-2、SSTR-3 mRNA水平,采用免疫组化检测SSTR-2、SSTR-3蛋白表达的水平。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验,Kaplan-Meier法分析患者生存情况,Cox分析肝细胞癌患者预后的影响因素。结果对照组SSTR-2、SSTR-3 mRNA及蛋白均显著高于试验组(t值分别为6.456、8.128,χ2值分别为7.992、9.157,P值均<0.05)。单因素分析显示,SSTR-2和SSTR-3 mRNA与肿瘤结节(t=6.533、5.041,P值均<0.05)、分化程度(t=4.672、4.013,P值均<0.05)、浸润深度(t=6.735、7.019,P值均<0.05)、病毒性肝炎(t=4.929、4.535,P值均<0.05)、酒精性肝炎(t=4.032、4.362,P值均<0.05)、糖尿病(t=4.372、6.293,P值均<0.05)等显著相关;SSTR-2和SSTR-3蛋白与肿瘤结节(χ2=25.223、15.399,P值均<0.05)、分化程度(χ2=7.535、10.944,P值均<0.05)、浸润深度(χ2=22.520、9.968,P值均<0.05)密切相关。SSTR-2和SSTR-3阴性表达组的累积术后无瘤生存率明显低于SSTR-2和SSTR-3亚型的阳性表达组(P值分别为0.015、0.004),SSTR-2和SSTR-3阴性表达组的术后总体生存率明显低于SSTR-2和SSTR-3亚型的阳性表达组(P值分别为0.009、<0.001)。Cox模型分析显示,SSTR-2蛋白、SSTR-3蛋白、肿瘤结节数目、肝硬化、静脉浸润是HCC术后总生存期的独立危险因素(P值均<0.05)。结论SSTR-2和SSTR-3亚型在肝细胞癌组织中表达低于非肝细胞癌患者,其低表达与肝细胞癌的常见侵袭转移特征及不良预后密切相关。生长抑素受体可能成为肝细胞癌的预后标志物。     

Clinical features and prognosis of early colorectal cancer treated by endoscopic mucosal resection

Background and Aims: The incidence of early colorectal cancer (ECC) has been increasing. The aim of this study was to evaluate the clinical outcome and prognosis of ECC treated by endoscopic mucosal resection (EMR). Methods: A total of 129 ECC patients who were initially treated by EMR between April 2005 and August 2007 were enrolled. Clinicopathological characteristics and prognoses were evaluated retrospectively. Results: En bloc resection was performed in 85% of ECC patients, and piecemeal resection was performed in 15% of patients. Clear lateral and deep margins were achieved in 86% of cases. Of the 129 patients, 64 were found to have intramucosal cancer and 65 had submucosal cancer. Clinical characteristics were not different between patients with intramucosal cancer and submucosal cancer; however, poor differentiation and the absence of background adenoma showed significant association with submucosal cancer. Seven patients with submucosal cancer underwent subsequent surgical resection; five had lymphovascular invasion or a positive resection margin, one had perforation, and one patient requested surgical resection. Of these seven patients, one had residual cancer and two had lymph node metastasis. All patients with intramucosal cancer had no recurrence during the follow‐up period. Seven patients with submucosal cancer showed adverse outcomes within 3 years, such as residual/recurrence of primary cancer or lymph node metastasis; five showed lymphovascular invasion or a positive deep margin, and two had no histological risk factors. Conclusions: Our results suggest that intramucosal cancer shows good prognosis, and a cure could be expected after EMR; however, adverse outcomes can occur in submucosal cancer. Therefore, meticulous endoscopic follow up is needed in patients with submucosal cancer for at least 3 years after EMR.     

腹腔镜手术治疗中晚期结直肠癌对比开腹手术的临床研究

目的 探讨腹腔镜手术治疗中晚期结直肠癌的可行性、安全性及治疗优势.方法 采用与同期开腹手术相比较的方法,将行中晚期结直肠癌切除的患者分为腹腔镜组(57例)和开腹组(56例),比较两组围手术期情况、不能够切除肝转移癌灶的处理情况及标本的临床病理结果,评价各组的肿瘤根治性、手术安全性、术后恢复情况及随访结果.结果 腹腔镜组术中出血量、术后离床时间、肛门排气时间、术后住院日数及术后并发症均明显减少(P＜0.05);术后应用吗啡镇痛的剂量明显减少(P＜0.01);腹腔镜下能够完成传统开腹手术肝转移癌灶的不同处理(P＞0.05);肿瘤根治性相关临床病理学结果提示两组病例完全可以达到相同的根治程度(P＞0.05);两组在局部复发和病死率方面差异无统计学意义(P＞0.05).结论 腹腔镜行中晚期结直肠癌切除术创伤小,术后恢复快,根治性确切,具有可行性、安全性及微创优势,急诊手术亦是可行的.     

Relationship between expression of laminin and pathological features in human colorectal carcinoma

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Clinical characteristics and prognosis of elderly patients with colorectal cancer: Comparison between surgical resection and supportive care

Elderly colorectal cancer (CRC) patients tend to avoid standard treatment, especially curative surgical resection, because of concerns about surgical complications or underlying diseases. This study is intended to compare clinical characteristics and prognosis between patients who had undergone surgical resection and received supportive care, and to evaluate the usefulness of surgical treatment in elderly patients.A total of 114 patients aged ≥80 years who were diagnosed with CRC were analyzed retrospectively. Of these patients, 73 patients underwent surgical resection for malignancy and 41 patients received supportive care. Clinicopathological factors and overall survival (OS) rates were compared.The surgical resection group had better Eastern Cooperative Oncology Group performance status, American Society of Anesthesiologists (ASA) physical status, and a lower stage than did the supportive-care group. The 3-year OS rate of the surgical group was significantly higher than that of the supportive-care group (60.7% vs 9.1%, P < .001). In extremely elderly patients (age ≥85 years), the surgical group showed a better 3-year OS rate than did the supportive-care group (73.9% vs 6.3%, P < .001), although Eastern Cooperative Oncology Group performance status and ASA physical status were not different. The post-operative mortality rate was 2.7%. In the analysis of risk factors related to survival, surgical resection was a good prognostic factor.Surgical treatment in elderly CRC patients showed a survival benefit, even in the extremely elderly patients. Surgical resection for CRC in elderly patients can be considered to improve survival.     

Clinical features and prognosis of hepatocellular carcinoma in young patients from a hepatitis B-endemic area

BACKGROUND AND AIM: Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. However, the clinical features of young HCC patients have not been fully studied. In the present study, we investigated the prevalence, clinical characteristics and prognosis of young HCC patients. METHODS: A retrospective analysis was performed for HCC patients in our center using Korean cancer registry data. Among 4234 patients enrolled, there were 38 patients younger than 30 years of age (0.9%). We compared clinical characteristics and survival data of these patients (group I) with those of sex-matched, randomly selected HCC patients aged 30-59 years (group II; n = 231) and 60 years or older (group III; n = 147). RESULTS: Group I showed distinct features compared with groups II and III as follows: low frequency of smoking history, high positive rate of hepatitis B s antigen, no association with anti-hepatitis C virus antibody, high frequency of alpha-fetoprotein > or = 400 ng/mL, well-preserved liver function, larger tumor size, more advanced tumor-node-metastasis (TNM) stage and Cancer of the Liver Italian Program (CLIP) score and more frequent application of surgical resection and chemotherapy as initial treatment. The overall survival of group I was worse than that of group II, but similar to that of group III. Multivariate analysis showed that TNM stage and CLIP score, not age itself, were independent predictive factors for survival. CONCLUSIONS: The results suggest that young HCC patients tend to have a poor prognosis owing to advanced tumor stage, despite well-preserved liver function and aggressive treatment. Further studies regarding the role of HCC screening in young people may be useful, especially in hepatitis B virus carriers from high endemic areas.