Prognostic significance of positive peritoneal cytology in endometrial carcinoma confined to the uterus

A retrospective analysis was performed to evaluate the prognostic significance of peritoneal cytology in patients with endometrial carcinoma limited to the uterus. A total of 280 patients with surgically staged endometrial carcinoma that was histologically confined to the uterus were examined clinicopathologically. The median length of follow-up was 62 (range, 12-135) months. All patients underwent hysterectomy and salpingo-oophorectomy with selective lymphadenectomy, and only three patients received adjuvant postoperative therapy. No preoperative adjuvant therapy was employed. In all, 48 patients (17%) had positive peritoneal cytology. The 5-year survival rate among patients with positive or negative peritoneal cytology was 91 or 95%, respectively, showing no significant difference (log-rank, P=0.42). The disease-free survival rate at 36 months was 90% among patients with positive cytology, compared with that of 94% among patients with negative cytology, and the difference was not significant (log-rank, P=0.52). Multivariate proportional hazards model revealed only histologic grade to be an independent prognostic factor of survival (P=0.0003, 95% CI 3.02 - 40.27) among the factors analysed (age, peritoneal cytology, and depth of myometrial invasion). Multivariate analysis revealed that histologic grade (P=0.02, 95% CI 1.21-9.92) was also the only independent prognostic factor of disease-free survival. We concluded that the presence of positive peritoneal cytology is not an independent prognostic factor in patients with endometrial carcinoma confined to the uterus, and adjuvant therapy does not appear to be beneficial in these patients.     

Prognostic significance of peritoneal lavage cytology in gastric cancer in Singapore

Background Peritoneal lavage cytology has been included as part of the staging process in the 13th edition of the Japanese Classification of Gastric Cancer. However, this procedure has neither been studied nor established in our population. We aimed to evaluate its prognostic relevance among our patients with gastric cancer. Methods A total of 142 consecutive patients with gastric carcinoma were recruited prospectively. All had histologically proven gastric carcinomas and had undergone laparotomy and intraoperative peritoneal lavage for cytological examination at Singapore General Hospital. The fluid recovered was centrifuged and stained by the Papanicolau method. All patients were followed up with endpoints of cancer recur-rence and mortality. Results There were 91 men and 51 women; 36 patients (25.4%) had positive peritoneal lavage. Patients with advanced macroscopic features, presence of vascular invasion, nodal involvement, advanced depth of tumor invasion and metastatic disease tended to have positive lavage, by univariate logistic regression analysis. Despite curative resections, patients with positive cytology had a more dismal disease-free survival (mean, 27 months vs 53 months; P < 0.0001 by log rank test) and higher recurrence rate (54.5% vs 19.3%; P = 0.007 by log rank test). There was also a trend towards earlier recurrences (median, 8 months vs 11 months; P = 0.37). By multivariate Cox regression stepwise analysis, advanced depth of tumor invasion and positive lavage cytology were found to be independent poor prognostic factors for disease-free survival. Conclusion Positive peritoneal lavage cytology correlated well with advanced features of gastric cancer. It is an independent poor prognostic factor and the procedure should be routinely performed. Integration of lavage status into our current staging systems may serve as a guide for adjuvant therapeutic options to improve the survival of gastric cancer in our population.     

胃癌患者腹腔游离癌细胞的检测及其临床意义

腹腔播散是进展期胃癌常见的转移方式,由于目前尚没有标准的检测胃癌腹腔微转移的方法,故大部分腹腔微转移的胃癌患者难以得到临床诊断。应用腹腔灌洗细胞学(PLC)检测腹腔游离癌细胞(IFCCs)的结果与腹腔镜检查结果相似,但是腹腔镜结合PLC可增加检查的敏感性。应用免疫组化和酶联免疫吸附试验可检测腹腔灌洗液(PLF)中IFCCs肿瘤标志,IFCCs预测胃癌复发的阳性预报值为91%,特异性为97%。应用免疫组化检测IFCCs是一个有效的、独立的预测胃癌生存期的阴性指标。应用酶联免疫吸附试验检测PLF中CEA水平是预测腹腔播散的指标,其诊断腹腔微转移的敏感性和特异性分别是75.8%和90.8%。应用PLF进行分子诊断的敏感性优于PLC、免疫组化和酶联免疫吸附试验。逆转录聚合酶链式反应(RTPCR)是一种新的诊断腹腔灌洗液中IFCCs的方法,基于靶基因的RTPCR方法可用于检测腹腔微转移的肿瘤分子标志。在IFCCs中表达的这些分子标志还可用于腹腔微转移治疗。存在IFCCs的胃癌患者的预后很差,无论应用哪种方法预测腹腔微转移都是困难的,但术前均应进行IFCCs检查,以明确诊断和指导治疗。     

Prognostic significance of the expression of vascular endothelial growth factor (VEGF) and VEGF-C in gastric carcinoma

BACKGROUND AND OBJECTIVES: Angiogenic factors play a major role in tumor growth and metastasis. The purpose of this study was to clarify the prognostic significance of the expression of vascular endothelial growth factor (VEGF) and VEGF-C in gastric carcinoma. METHODS: Formalin-fixed and paraffin embedded sections of tumor tissue were obtained from 76 patients who underwent curative gastrectomy for gastric carcinoma. Immunohistochemical staining for VEGF and VEGF-C was performed. RESULTS: VEGF and VEGF-C were positively expressed in 39 and 45% of the patients, respectively. No correlation existed between VEGF and VEGF-C expressions. VEGF expression was significantly correlated with venous invasion. VEGF-C expression was significantly correlated with lymphatic and venous invasion. Patients with positive staining for VEGF showed a significantly lower survival rate than VEGF negative patients. After subdivision, according to the combination of VEGF and VEGF-C expression, VEGF-C expression had a significant unfavorable impact on prognosis among patients with negative staining for VEGF. The expression of VEGF and/or VEGF-C was independent prognostic determinant by the multivariate survival analysis. CONCLUSIONS: The positive expression for VEGF and/or VEGF-C was an important prognostic determinant after curative gastrectomy for gastric carcinoma. VEGF-C may stimulate the tumor progression in the absence of VEGF.     

Immunocytology improves prognostic impact of peritoneal tumour cell detection compared to conventional cytology in gastric cancer.

AIMS: Studies on the value of peritoneal tumour cell dissemination for prognosis in gastric cancer using various methods to detect tumour cells have produced conflicting conclusions. We studied the incidence and prognostic relevance of microscopic intraperitoneal tumour cell dissemination in gastric cancer, comparing conventional and immunocytological detection. METHODS: Peritoneal wash-outs of 111 consecutive gastric patients without overt peritoneal carcinomatosis, including 75 curatively resected patients, were studied. Sixty patients with benign disorders served as controls. 100 ml of warm NaCl 0.9% was instilled intraoperatively and 20 ml was reaspirated. The specimens were stained peri-operatively with H&E. In the last 47 patients (30 of whom were curatively resected) additional immunostaining with the HEA-125 antibody was performed. The results of cytology were correlated with the TNM categories and with post-operative follow-up. RESULTS: Of the patients, 42.3% and 48.9% were positive when conventional and immunocytological staining were employed, respectively. Conventional cytology was significantly associated with the pT and M categories. Immunocytology was significantly associated with the pT, pN and M caterogies. In four of 30 curatively resected patients (13.3%), the results of conventional and immunocytology were different. Three patients with positive immunocytology but negative conventional cytology died during follow-up (median follow-up 45.3 months), whereas one patient with positive conventional but negative immunocytology is still alive. In an univariate analysis 4 years post-surgery, positive immunocytology was significantly associated with an unfavourable prognosis in patients with curatively resected gastric cancer. While only 28.6% (six of 21) of the patients with negative immunocytology had died, this proportion increased to 77.8% (seven of nine) with positive immunocytology (P=0.018). The mean survival of negative vs positive patients amounted to 1205+/-91 vs 772+/-147 days (P=0.007). In contrast, in conventional cytology we found no significantly different survival time between negative and positive patients. CONCLUSIONS: Immunocytology seems to be superior to conventional cytology and should be preferred.     

Pathology and prognosis of gastric carcinoma: well versus poorly differentiated type

BACKGROUND: The most important parameters predicting outcome of patients with gastric carcinoma are the depth of wall invasion and the status of lymph node metastasis, but the prognostic significance of histologic type is unclear. The aim of this study was to clarify the prognostic value of two major histologic types of gastric carcinoma, that is well and poorly differentiated types. METHODS: Histopathologic findings and outcomes of 504 patients with gastric carcinoma were evaluated by well and poorly differentiated types. Well differentiated gastric carcinoma (WGC) included papillary and tubular adenocarcinomas, poorly differentiated medullary carcinoma, and well differentiated mucinous carcinoma; whereas poorly differentiated gastric carcinoma (PGC) included poorly differentiated scirrhous carcinoma, signet ring cell carcinoma, and poorly differentiated mucinous carcinoma. RESULTS: Patients with WGC were characterized by old age, male predominance, tumor location in the lower third of the stomach, small tumor size, and liver metastasis; whereas patients with PGC were distinguished by their tumor location in the middle third of the stomach, serosal invasion, lymph node metastasis, advanced stage, and peritoneal dissemination. The overall 5-year survival rate for patients with WGC was higher than that for patients with PGC (76% vs. 67%; P = 0.058), especially for patients with >/= 10 cm tumors (42% vs. 14%; P = 0.017). The 5-year survival rate for patients with serosa positive but node negative tumors was higher in WGC patients than in PGC patients (83% vs. 59%; P = 0.086); whereas the 5-year survival rate for patients with serosa negative but node positive tumors was lower in WGC patients than in PGC patients (63% vs. 88%; P = 0.008). Multivariate analysis indicated that among pathologic variables of the tumor, histologic type (WGC vs. PGC) was one of the independent prognostic factors. CONCLUSIONS: Histologic type is important for estimating the tumor progression and outcomes of patients with gastric carcinoma. In addition to the depth of wall invasion and status of lymph node metastasis, histologic type, including well or poorly differentiated type, should be evaluated in the management of gastric cancer.     

Prognostic significance of peritoneal washing cytology in Thai patients with gastric adenocarcinoma undergoing curative D2 gastrectomy

Background The aim of the present study was to determine the prognostic significance of peritoneal washing cytology (PWC) among Thai patients with gastric adenocarcinoma. Methods Medical charts of 97 patients with gastric adenocarcinoma who underwent curative D2 gastrectomy between October 1995 and September 2005 were reviewed. Results A total of 22 patients (23%) had positive PWC. Factors significantly associated with positive PWC included tumor location, macroscopic findings, histology, depth of tumor invasion, nodal involvement, TNM stage, and angiolymphatic invasion. Positive PWC was found only in tumors invading the serosa. All patients with positive PWC developed peritoneal recurrence. The sensitivity and specificity of positive PWC in predicting peritoneal recurrence were 61% and 100%, respectively. The overall 5-year survival rates for patients with positive and negative PWC were 0% and 75%, respectively. Conclusion Gastric adenocarcinoma with positive PWC should be considered stage IV disease. PWC should be included in the staging of gastric adenocarcinoma.     

Protein levels of tissue inhibitor of metalloproteinase-1 in tumor extracts as a marker for prognosis and recurrence in patients with gastric cancer

Background Tissue inhibitor of metalloproteinase-1 (TIMP-1) correlates with tumor progression in patients with gastric cancer; however, the clinical significance of TIMP-1 as a marker for prognosis and recurrence has not been fully clarified. Methods TIMP-1 protein was measured by an enzyme-linked immunosorbent assay in tumor samples from 86 patients who had undergone surgical resection. An intratumoral TIMP-1 value of 10.0 ng/mg protein or more was defined as positive. Patients were followed up for more than 5 years prospectively. Results Thirty-one of the 86 patients (36.0%) were positive for TIMP-1. Kaplan-Meier curves for overall survival were significantly different between patients who were positive and those who were negative for TIMP-1. Univariate analysis of factors affecting overall survival showed that depth of tumor invasion; lymph node metastasis; peritoneal dissemination; lymphatic invasion; venous invasion; Lauren classification of histology; curability; and TIMP-1 were statistically significant. Stepwise multivariate analysis for overall survival demonstrated that depth of tumor invasion, nodal metastasis, peritoneal dissemination, and TIMP-1 remained independent prognostic factors. Kaplan-Meier curves for disease-free survival were significantly different between patients who were positive and those who were negative for TIMP-1. The incidence of recurrence was significantly higher in patients positive for TIMP-1 than in those who were negative for TIMP-1. The frequency at each site of recurrence was higher in patients positive for TIMP-1. Conclusion These results suggested that the protein concentration of TIMP-1 in the tumor extracts was a useful marker for overall survival, disease-free survival, and disease recurrence in patients with gastric cancer. Thus, tumor TIMP-1 may serve to identify a high-risk group, for whom optimal surgical and medical treatment can be given.     

胃癌组织中Ets-1的表达及其与血管生成临床病理特征和预后的关系

目的 探讨胃癌组织、癌旁组织及淋巴结转移灶中Ets-1表达的临床意义,分析Ets-1表达与血管生成、临床病理特征及预后的关系.方法 应用免疫组化SP法,采用组织芯片技术,检测189例胃癌组织、54例癌旁组织、41例淋巴结转移灶及32例正常胃黏膜中Ets-1蛋白的表达.对胃癌患者通过上门或电话进行问卷随访.结果 胃癌组织、癌旁组织和正常胃黏膜Ets-1的阳性表达率分别为71.4%、29.6%和18.8%,3组间差异有统计学意义(P＜0.01).135例Ets-1表达阳性的胃癌组织微血管密度(MVD)为30.42±15.21,54例Ets-1表达阴性的胃癌组织MVD为25.73±11.50.两组差异有统计学意义(P=0.042).Ets-1蛋白表达与浸润深度、淋巴结转移有关(P＜0.01),与性别、年龄、肿瘤大小、分化程度、Lanren分型无关(P＞0.05).41例淋巴结转移灶和相对应的41例胃癌组织Ets-1表达阳性率分别为84.4%和58.5%,差异有统计学意义(P=0.007).单因素分析显示,Ets-1表达对胃癌患者生存期的影响有统计学意义(P＜0.05),Cox多元回归分析显示,Ets-1表达不是胃癌患者预后的独立影响因素(P＞0.05).结论 Ets-1在促进胃癌血管生成中发挥着重要作用,在胃癌的发生、发展中扮演了重要角色,Ets-1表达对胃癌患者的生存期有一定影响,胃癌淋巴结转移灶和原发灶肿瘤组织中Ets-1的表达不同,具有异质性.     

Peritoneal cytology: impact on disease-free survival in clinical stage I endometrioid adenocarcinoma of the uterus

The prognostic significance of positive peritoneal cytology in endometrial carcinoma has led to the incorporation of peritoneal cytology into the current FIGO staging system. While cytology was shown to be prognostically relevant in patients with stage II and III disease, conflicting data exists about its significance in patients who would have been stage I but were classified as stage III solely and exclusively on the basis of positive peritoneal cytology (clinical stage I). Analysis was based on the data of 369 consecutive patients with clinical stage I endometrioid adenocarcinoma of the endometrium. Standard treatment consisted of an abdominal total hysterectomy, bilateral salpingo-oophorectomy with or without pelvic lymph node dissection. Peritoneal cytology was obtained at laparotomy by peritoneal washing of the pouch of Douglas and was considered positive if malignant cells could be detected regardless of the number of malignant cells present. Disease-free survival (DFS) was considered the primary statistical endpoint. In 13/369 (3.5%) patients, positive peritoneal cytology was found. The median follow-up was 29 months and 15 recurrences occurred. Peritoneal cytology was independent of the depth of myometrial invasion and the grade of tumour differentiation. Patients with negative washings had a DFS of 96% at 36 months compared with 67% for patients with positive washings (log-rank P<0.001). The presence of positive peritoneal cytology in patients with clinically stage I endometrioid adenocarcinoma of the endometrium is considered an adverse prognostic factor.     

Clinicopathologic features and prognosis analysis of mucinous gastric carcinoma

Mucious gastric carcinoma (MGC) is a subtype of gastric carcinoma and its clinicopathologic features and prognosis still remain unclear. To investigate the clinical significance and surgical outcomes of mucinous gastric carcinoma, 2,769 patients with gastric carcinoma were analyzed in a case control study. We reviewed the records of 196 patients with mucinous gastric carcinoma and 2,573 with nonmucinous gastric carcinoma (NGC). Clinicopathologic features and survival rate of patients were analyzed. In all registered patients, patients with MGC had a larger size, more T3 and T4 invasion to the gastric wall, more positive lymph node metastasis, more III and IV stage and more positive peritoneal dissemination, but less curative gastrectomy. In curative gastrectomy patients, MGC had larger size, deeper invasion to gastric wall, more positive lymph node metastasis and more advanced TNM stage. The overall survival rate in curative gastrectomy patients with MGC was significantly lower than that for patients with NGC (P < 0.021). Age (P = 0.001), location of tumor (P < 0.001), Borrmann type (P = 0.037), depth of invasion (P < 0.001), lymph node metastasis (P < 0.001) and lymphovascular invasion (P = 0.001) were independent prognostic factors of gastric carcinoma, but MGC itself was not. The prognosis of MGC did not have significant difference compared with NGC. Frequently, MGC was of advanced stage at the time of diagnosis. Age, location of tumor, Borrmann type, depth of invasion, lymph node metastasis and lymphovascular invasion are independent prognostic factors of gastric carcinoma, but mucinous histological type itself is not. Further study on the origin and progression of MGC is needed in future.     

细胞周期素E和P53蛋白在胃癌组织中表达及预后意义

目的 :研究细胞周期素E(cyclinE)和P53蛋白在胃癌组织中的表达水平及其与生物学行为和对预后的作用。方法 :应用免疫组化方法检测 1 2 8例胃癌组织中cyclinE和P53蛋白表达水平。 结果 :本组 1 2 8例中 ,cyclinE蛋白阳性 57例 ,占 44 .5 % ;P53蛋白阳性 67例 ,占 52 .3 % ,P53 +/cyclinE +者 48例 ,占 37.5 %。胃癌组织中cyclinE和P53蛋白表达水平与肿瘤大小、浸润深度、局部淋巴结转移、脉管侵犯和远处转移均相关。单因素生存分析显示 ,cyclinE阳性表达组五年生存率 (5 .3 % )显著低于cyclinE表达阴性组 (36 .6 % ,P <0 .0 0 1 ) ,P53蛋白表达阳性的病例五年生存率 (7.8% )显著低于P53表达阴性的病例 (2 2 .6 % ,P <0 .0 0 1 ) ,cyclinE和P53均阳性的病例五年生存率 (2 .3 % ) ,明显低于其他组的病例 (2 7.3 % ,P <0 .0 0 5)。COX模型多因素分析显示 ,cyclinE蛋白表达水平是独立的预后指标 ,P53蛋白表达水平不能作为独立的预后指标。结论 :CyclinE在胃癌中表达具有一定的预后意义 ,P53蛋白在胃癌中表达与肿瘤的生物学行为有关     

Thymidine phosphorylase expression correlates with malignant potential and anti-tumor effect of doxifluridine on gastric cancer: multivariate analysis for adjuvant chemotherapy doxifluridine vs. 5-fluorouracil

Doxifluridine (5'-DFUR) is an anticancer drug converted to 5-fluorouracil (5-FU) by thymidine phosphorylase (TP). TP is an angiogenetic and platelet-derived endothelial cell growth factor. We evaluated the relation between TP expression and chemotherapeutic efficacy and prognosis for gastric cancer. Advanced gastric cancer patients given oral adjuvant chemotherapeutics either 5'-DFUR; 163 patients or 5-FU; 162 patients were examined. TP expression was assessed with immunohistochemical staining. Multivariate analysis for influencing survival was done, employing variables such as gender, age, procedure, tumor size, location, Borrmann type, histologic factors [type, depth of invasion, lymph node metastasis (n), lymphatic invasion (ly), and venous invasion (v)], drug administered, and TP expression. In the patients with serosal invasion, 5'-DFUR in TP positive was an independent prognostic factor (risk ratio, 4.450; 95% confidence limit, 2.099-9.436), indicating significantly improved prognosis over the 5-FU group. In TP negative, n and ly were independent prognostic factors, but the survival curves of the two chemotherapeutic groups were not significantly different. TP expression was not prognostic factor in 5'-DFUR group, while, in 5-FU group, TP expression was an independent prognostic factor (2.834, 1.467-5.476). In conclusion, it was suggested that TP positive gastric cancer with serosal invasion increased malignant potential of the tumor and 5'-DFUR efficacy.     

TP/PD-ECGF表达与血小板增多在胃癌中的意义

目的:研究血小板衍化内皮细胞生长因子(TP/PD-ECGF)在胃癌中的表达及血小板增多情况,并对其与胃癌患者临床病理特征和预后的关系进行探讨。方法:采用免疫组化EnVision两步法检测107例胃癌组织中TP/PD-ECGF的表达,记录血小板增多情况,并分析二者与胃癌患者临床病理特征及预后的关系。结果:胃癌患者中TP/PD-ECGF阳性表达率为71.0%,与血小板增多呈正相关(P<0.01)。TP/PD-ECGF表达、血小板增多与肿瘤分期、淋巴结转移、远处转移及分化程度呈正相关。TP/PD-ECGF阳性与阴性表达患者3年、5年总生存率分别为69.04%、18.12%和88.87%、75.20%,二者差异有统计学意义(P=0.0383);3年、5年无进展生存率分别为64.87%、17.92%和82.73%、35.00%,二者差异有统计学意义(P=0.0350)。Cox比例风险模型多因素分析显示,肿瘤分期、淋巴结转移、远处转移、TP/PD-ECGF及血小板增多均是影响胃癌预后独立的危险因素。结论:TP/PD-ECGF表达与血小板增多呈正相关,二者与胃癌生长和浸润转移关系密切,可作为胃癌独立的预后因素。     

Association of tumour vasculature with tumour progression and overall survival of patients with non-early gastric carcinomas.

In order to investigate the relationship between intratumoral vasculature and progression of gastric carcinomas and between vessel counts and survival of patients with non-early gastric carcinoma, we counted the intratumoral microvessels and compared their numbers with clinicopathological parameters, as well as with the patients'' survival. Microvessels were stained with anti-CD34 monoclonal antibody before counting by microscopy (x200). In a group of 181 patients who had undergone tumour resection and were followed for more than 24 months the vessel counts for 83 patients with stage IV disease were significantly higher than those for patients with any other stage of disease. Among various clinicopathological variables, haematogenous metastasis, lymph node metastasis, peritoneal metastasis, stage IV disease and non-curative resection were more frequent in the patients with highly vascularized tumours (intratumoral vessel count > 155) than in those with less vascularized tumours. As a classification of stage IV disease such as haematogenous or peritoneal metastasis generally indicates non-curative resection, it can be considered that the development of stage IV disease is associated with the increase in tumour angiogenesis. Both univariate and multivariate analyses showed that the intratumoral vessel count was significantly predictive of overall survival, when tested as either a continuous or dichotomous variable. Cox hazards model analysis showed that the vessel count was one of the significant and independent prognostic variables. Patients with highly vascularized tumours were significantly more likely to die than those with less vascularized tumours. Assessment of tumour vasculature may therefore be important, not only for its prognostic value, but also as it may help to predict responses to angiogenesis-inhibiting agents.     

S100钙结合蛋白A2在胃癌组织中的表达及意义

目的:探讨S100A2在慢性胃炎、肠上皮化生和胃癌组织样本中的表达及与胃癌临床病理特征及预后的关系。方法:利用HE染色对所取胃组织标本进行病理组织学诊断;采用免疫组织化学方法检测标本S100A2蛋白的表达;qRT-PCR法检测S100A2 mRNA表达;Western blot检测S100A2蛋白的表达;采用Kaplan-Meier分析累积生存率。 结果:应用qRT-PCR方法分析不同胃组织标本S100A2 mRNA的表达水平,发现S100A2 mRNA的表达水平按以下顺序递减:胃炎,肠上皮化生,胃癌(P<0.001),与Western bolt分析S100A2蛋白的表达评定结果相吻合。免疫组化分析:S100A2在胃炎、肠上皮化生和胃癌组织细胞质中表达,S100A2阳性表达率为胃炎100％(73/73),肠上皮化生90.7％(78/86),胃癌48.9％(170/348) (P<0.001)。在胃癌中,S100A2蛋白的表达缺失在青年患者中多于老年患者。S100A2蛋白的表达与肿瘤大小、浸润深度、淋巴管和静脉浸润、淋巴结转移、肿瘤TNM分期呈负相关,并随胃癌分化程度降低,在高分化癌、中分化癌和低分化癌中,S100A2的阳性表达率分别为65.9%、56.4%和17.2%(P<0.05),和患者性别无相关性(P>0.05)。Kaplan-Meier分析累积生存率显示:弱或中度S100A2基因表达的患者累积生存率明显高于不表达S100A2的患者。多因素分析显示S100A2表达、浸润深度、淋巴管及静脉浸润、淋巴结转移、TNM分期是胃癌患者预后的独立因素。结论:在胃炎-肠上皮化生-胃癌过程中S100A2 mRNA和蛋白表达逐渐降低。S100A2表达与肿瘤大小、浸袭深度、淋巴管和静脉侵犯、淋巴结转移及TNM分期负相关,并随胃癌分化程度降低,S100A2的阳性表达率逐渐降低。S100A2表达是独立的胃癌预后预测因素,是胃癌患者预后良好的指标之一。     

胸苷磷酸化酶在胃癌中的表达及临床意义

目的：探讨胸苷磷酸化酶（ＴＰ）在胃癌中的表达及临床意义。方法：采用免疫组织化学法检测２０４例胃癌患者肿瘤组织中ＴＰ的表达,并探讨与临床病理因素、术后辅助化疗和预后之间的关系。结果：胃癌组织ＴＰ表达阳性率为４７.１％。ＴＰ阳性表达患者中位生存时间为３０.９４个月,ＴＰ阴性表达患者为３４.４３个月,两者比较有显著的统计学差异（Ｐ＝０.００２）。ＴＰ阳性表达与患者年龄、发病部位、ＴＮＭ分期、浸润深度、淋巴结转移等病理因素以及与以氟尿嘧啶为主的辅助化疗的疗效无明显相关性。结论：ＴＰ表达与胃癌患者长期生存有一定的相关性,有可能成为预测胃癌预后的一个参考指标。     

TP/PD-ECGF表达与血小板增多在胃癌中的意义

目的：研究血小板衍化内皮细胞生长因子（TP/PD-ECGF）在胃癌中的表达及血小板增多情况,并对其与胃癌患者临床病理特征和预后的关系进行探讨。方法：采用免疫组化EnVision两步法检测107例胃癌组织中TP/PD-ECGF的表达,记录血小板增多情况,并分析二者与胃癌患者临床病理特征及预后的关系。结果：胃癌患者中TP/PD-ECGF阳性表达率为71.0%,与血小板增多呈正相关（P〈0.01）。TP/PD-ECGF表达、血小板增多与肿瘤分期、淋巴结转移、远处转移及分化程度呈正相关。TP/PD-ECGF阳性与阴性表达患者3年、5年总生存率分别为69.04%、18.12%和88.87%、75.20%,二者差异有统计学意义（P=0.0383）;3年、5年无进展生存率分别为64.87%、17.92%和82.73%、35.00%,二者差异有统计学意义（P=0.0350）。Cox比例风险模型多因素分析显示,肿瘤分期、淋巴结转移、远处转移、TP/PD-ECGF及血小板增多均是影响胃癌预后独立的危险因素。结论：TP/PD-ECGF表达与血小板增多呈正相关,二者与胃癌生长和浸润转移关系密切,可作为胃癌独立的预后因素。     

肿瘤抑制基因PTEN在胃癌中的表达及其临床意义

目的　研究第 10号染色体同源丢失性磷酸酶 -张力蛋白基因 (phosphatase and tensin homology delet-ed on chrom osom e ten,PTEN)在胃癌组织中的表达水平以及与生物学行为的关系和对预后评价的意义。方法　以免疫组化方法检测 10 6例胃癌组织中 PTEN蛋白的表达水平。结果　 10 6例胃癌中 ,PTEN表达阳性 72例(6 7.9% ) ,其中弱阳性 15例 (14 .1% ) ,强阳性 5 7例 (5 3.8% )。在胃癌组织中 ,PTEN蛋白水平与胃壁浸润深度、组织分化类型 ,临床分期等相关 (P<0 .0 5 ) ;单变量生存分析 ,PTEN蛋白阳性表达组 3、5年生存率分别为 4 8.6 %、37.5 % ,高于阴性表达组 32 .4 % ,11.8% ,但经 L og- rank时序检验示差异无显著性 (P=0 .0 72 1)。 Cox回归模型多变量分析显示 ,PTEN不是一个独立的预后指标。结论　 PTEN与胃癌的发生发展有关 ,但不是判断胃癌预后的一个独立指标