血管内皮生长因子的表达与亚洲胃癌患者病理学特征相关性的Meta分析

目的:利用Meta分析定量评价血管内皮生长因子(vascular endothelial growth factor,VEGF)与亚洲胃癌患者临床病理学特征的关联性.方法:检索PubMed、中国知网(China National Knowledge Infrastructure,CNKI)和维普全文期刊数据库中所有已发表胃癌组织中VEGF表达与病理学参数及其预后的相关性研究,应用STATAg.0SE软件进行不同组间VEGF表达比值比(odd ratio,OR)和95％可信区间(95％ confidence interval,CI)以及文献异质性和偏倚评估.结果:共纳入132篇研究文献;胃癌组织中VEGF的表达显著高于正常胃黏膜组织(P=0.000);且癌组织中VEGF的表达与肿瘤浸润深度(OR=3.32,95％ CI=2.82～3.91)、淋巴转移(OR=3.52,95％CI=3.02～4.10)、远处转移(OR=2.88,95％ CI=1.94～4.27)、静脉侵犯(OR=2.19,95％CI=1.68～2.85)和TNM分期(OR=3.98,95％ CI=3.31～4.78)均有显著相关性.结论:VEGF蛋白可作为预测胃癌浸润转移以及评价患者预后的生物学指标,成为胃癌诊治中较有价值的早期分子标志物.     

乙酰肝素酶mRNA表达和血管生成与胃癌发展的关系

目的　探讨乙酰肝素酶mRNA表达状况和血管生成与胃癌发展的关系。方法　应用原位杂交技术 ,检测 5 2例胃癌组织中乙酰肝素酶mRNA的表达情况 ,并用免疫组化法对全部标本用CD34抗体进行肿瘤血管内皮染色 ,计数肿瘤微血管密度 (MVD) ,分析乙酰肝素酶mRNA与MVD及其与胃癌组织分化程度、浸润深度、淋巴结转移和器官转移的关系。结果　胃癌组织乙酰肝素酶mRNA阳性表达 2 5例 (4 8.1% ) ,MVD平均值为 73.2± 2 2 .8;阴性表达 2 7例 (5 1.9% ) ,MVD平均值为 4 4 .8±11.9,两者之间差异有显著性 (P <0 .0 0 1)。乙酰肝素酶mRNA表达和MVD与胃癌组织浸润深度、淋巴结转移有关 (P <0 .0 0 5 )。结论　乙酰肝素酶与胃癌的血管生成密切相关 ,对胃癌的生长和浸润转移有促进作用 ,乙酰肝素酶可作为反映胃癌生物学行为的客观指标。     

Clinicopathologic Features Predicting Involvement of Nonsentinel Axillary Lymph Nodes in Iranian Women with Breast Cancer

Background: Almost half of the breast cancer patients with positive sentinel lymph nodes have no additional disease in the remaining axillary lymph nodes. This group of patients do not benefit from complete axillary lymph node dissection. This study was designed to assess the clinicopathologic factors that predict non-sentinel lymph node metastasis in Iranian breast cancer patients with positive sentinel lymph nodes. Materials and Methods: The records of patients who underwent sentinel lymph node biopsy, between 2003 and 2012, were reviewed. Patients with at least one positive sentinel lymph node who underwent completion axillary lymph node dissection were enrolled in the present study. Demographic and clinicopathologic characteristics including age, primary tumor size, histological and nuclear grade, lymphovascular invasion, perineural invasion, extracapsular invasion, and number of harvested lymph nodes, were evaluated. Results: The data of 167 patients were analyzed. A total of 92 (55.1%) had non-sentinel lymph node metastasis. Univariate analysis of data revealed that age, primary tumor size, histological grade, lymphovascular invasion, perineural invasion, extracapsular invasion, and the number of positive sentinel lymph nodes to the total number of harvested sentinel lymph nodes ratio, wereassociated with non-sentinel lymph node metastasis. After logistic regression analysis, age (OR=0.13; 95% CI, 0.02-0.8), primary tumor size (OR=7.7; 95% CI, 1.4-42.2), lymphovascular invasion (OR=19.4; 95% CI, 1.4-268.6), extracapsular invasion (OR=13.3; 95% CI, 2.3-76), and the number of positive sentinel lymph nodes to the total number of harvested sentinel lymph nodes ratio (OR=20.2; 95% CI, 3.4-121.9), were significantly associated with non-sentinel lymph node metastasis. Conclusions: According to this study, age, primary tumor size, lymphovascular invasion, extracapsular invasion, and the ratio of positive sentinel lymph nodes to the total number of harvested sentinel lymph nodes, were found to be independent predictors of non-sentinel lymph node metastasis.     

Associations of matrix metalloproteinase-9 protein polymorphisms with lymph node metastasis but not invasion of gastric cancer.

PURPOSE: Like most cancers, gastric cancer has a complex multistep etiology that involves both environmental and genetic factors. Matrix metalloproteinase-9 (MMP-9) is frequently overexpressed in gastric cancer. We investigated the effect of the genetic differences in MMP-9 coding region on the occurrence and progression of gastric cancer. EXPERIMENTAL DESIGN: A case-control study was conducted in a population of 74 patients and 100 healthy people in southeast China. Individuals were genotyped for two single nucleotide polymorphisms (SNP) in MMP-9: R279Q and P574R. Genotypic distributions between patient and control groups were compared for correlations with cancer occurrence. Associations between genotypic distributions and several clinicopathologic features were also analyzed using univariate tests, multivariate logistic regression modeling, and stratified analyses. RESULTS: Significant associations were revealed between both SNPs and lymph node metastasis [P = 0.012 and 0.025; odds ratio (OR), 3.4 and 2.8, respectively]. After adjustment using logistic regression for the potential confounding effects of gender, age, and location of the tumors, homozygous MMP-9 279RR and 574PP are more evidently associated with lymph node metastasis with OR(adjusted) of 5.7 [95% confidence interval (95% CI), 1.80-18.34] and 4.2 (95% CI, 1.37-12.69). The homozygous 279R-574P haplotype showed a stronger association by an OR(adjusted) of 6.1 (95% CI, 1.92-12.29) and was also associated with the 1-year postoperative mortality (OR(adjusted), 6.5; 95% CI, 1.18-35.74). Interestingly, our data also suggested that the MMP-9 polymorphisms seem to result in higher risk of lymph node metastasis through a pathway independent of cancer invasion because no positive associations were found between these polymorphisms and cancer invasion (OR, 0.59 < 1). The stratified analyses indicated a synergistic interaction between the MMP-9 polymorphisms and the type of diffuse in affecting lymph node metastasis (OR, 13.4; P(between strata) = 0.04). Significant association between both SNPs and the overall occurrence of gastric cancer was not observed. CONCLUSION: The present study has shown significant associations between the two nonsynonymous MMP-9 polymorphisms with lymph node metastasis in gastric cancer, especially with the diffuse type. The relatively large values of ORs and disassociation with cancer invasion suggest that the genetic differences of MMP-9 protein play an important and specific role in lymph node metastases, and therefore, further investigation of the underlying molecular mechanism is warranted.     

乙酰肝素酶基因表达与胃癌临床病理特点的关系

目的探讨乙酰肝素酶基因(HPAmRNA)在胃癌中的表达及其与临床病理因素之间的相互关系。方法选用43例胃癌组织和10例癌旁正常胃组织,用逆转录聚合酶链反应(RTPCR)检测标本中HPAmRNA的表达,并结合患者临床病理指标进行分析。结果43例胃癌中,29例HPAmRNA表达阳性,其阳性率显著高于癌旁正常胃组织(P=0.013)。HPAmRNA的表达与TNM分期、有无浆膜浸润、淋巴结转移、远处转移以及与肿瘤大小有相关性(P<0.05);与患者年龄、性别、肿瘤所在部位、肿瘤的Borrmann分型、组织学类型、分化程度、腹膜转移和肝转移无相关性(P>0.05)。结论HPAmRNA阳性表达的胃癌有较高的侵袭转移性,HPA可能是胃癌侵袭转移中的一个重要酶,可能与胃癌的淋巴结转移有关。     

胃癌原发灶和淋巴结转移灶HER2表达的临床意义

目的 观察HER2在胃癌原发灶和淋巴结转移灶中的表达及其临床意义.方法 选取胃癌患者140例,其中淋巴结转移94例.采集胃癌患者的原发灶、淋巴结转移灶及癌旁组织,采用免疫组织化学法(Elivision)方法检测3种组织中HER2蛋白表达情况.结果 140例胃癌原发灶组织中HER2蛋白阳性表达与胃癌TNM分期、浸润深度及淋巴结转移有关(P<0.05),而与患者性别、年龄和分化程度无关(P>0.05),癌旁组织中HER2表达与性别、年龄、分化程度、TNM分期、浸润深度及淋巴结转移均无关(P>0.05);HER2蛋白在胃癌原发灶、淋巴结转移灶中表达水平均高于癌旁组织,差异有统计学意义,而94例淋巴结转移灶和对应的胃癌原发灶中HER2表达的差异无统计学意义;94例有淋巴结转移的患者淋巴结转移灶与原发灶HER2表达一致率为89.4%,两类标本HER2表达状态具有一致性(Z=6.386,P<0.001).结论 胃癌HER2蛋白的阳性表达与胃癌TNM分期、浸润深度及淋巴结转移有关,提示HER2的表达与胃癌的浸润转移有关;胃癌原发灶和淋巴结转移灶HER2的表达具有较好的一致性,患者在不能获取原发病灶的情况下,检测转移灶中HER-2可能为靶向治疗的选择提供依据,为晚期胃癌患者带来希望.     

The prognostic value of E‐cadherin in gastric cancer: A meta‐analysis

The prognostic impact of E‐cadherin downregulation in gastric cancer has been assessed for years while the results are controversial and heterogeneous. We thus comprehensively reviewed the evidence for evaluation of E‐cadherin expression in gastric cancer to determine this effect. We searched PubMed and Embase to identify eligible studies, and 26 studies comprising 4,383 gastric cancer patients were included to assess the association between E‐cadherin immunohistochemical expression and overall survival (OS) and clinicopathological characteristics. Summary hazard ratios (HRs) or odds ratios (ORs) with 95% confidence interval (95% CI) were calculated to estimate the effect. We also performed meta‐regression and subgroup analysis according to study location, publication year, number of patients, quality score of studies and cut‐off value. Reduced E‐cadherin expression was significantly correlated with poor OS of gastric cancer patients (HR 1.62, 95% CI 1.34–1.96). Subgroup analysis indicated that E‐cadherin low‐expression had an unfavorable impact on OS in Asian patients (HR 1.87, 95% CI 1.45–2.41). Moreover, downregulation of E‐cadherin was significantly associated with TNM stage (OR 2.52, 95% CI 1.85–3.43), the depth of invasion (OR 2.01, 95% CI 1.39–2.90), lymph node metastasis (OR 2.39, 95% CI 1.68–3.40), distant metastasis (OR 2.23, 95% CI 1.21–4.11), grade of differentiation (OR 2.26, 95% CI 1.60–3.21), vascular invasion (OR 1.86, 95% CI 1.10–3.13) and histological type of gastric cancer (OR 4.22, 95% CI 2.96–6.02). This meta‐analysis revealed that E‐cadherin expression might be a predicative factor of poor prognosis for gastric cancer particularly in Asia.     

骨桥蛋白mRNA在胃癌中的表达及其临床意义

目的 研究胃癌中骨桥蛋白(OPN)mRNA的表达及其与临床病理特征之间的关系,阐明骨桥蛋白在胃癌侵袭和转移过程中的作用。方法 应用半定量RT-PCR方法,检测OPN mRNA在胃癌组织中的表达和相对含量,分析OPN mRNA的相对含量与胃癌临床病理特征的关系。结果 66例胃癌组织中,50例标本可扩增出330bp的条带,OPN mRNA的阳性表达率为75．8％(50／66)。20例正常胃黏膜组织OPN mRNA的表达全部为阴性。OPN mRNA的表达与肿瘤侵袭深度、肿瘤直径、淋巴结转移程度及有无远处转移有关,与肿瘤的分化程度无关。66例患者随访10～27个月(平均16个月)。OPN mRNA表达阳性组50例中复发15例,表达阴性组16例中仅复发1例(P=0．05);OPN mRNA表达阳性组中死亡10例,表达阴性组无一例死亡(P=0．05)。结论 胃癌中,骨桥蛋白mRNA的表达增高。OPN mRNA的高表达反映了胃癌病情的进展,并且与患者的预后有关。骨桥蛋白在胃癌的远处转移过程中可能起着重要的作用。     

Expression of stromal cell-derived factor-1α is an independent risk factor for lymph node metastasis in early gastric cancer

Lymph node metastasis is considered to be a significant prognostic factor for early gastric cancer (EGC). However, no real consensus exists on which patient and/or tumor characteristics are associated with lymph node metastasis. We investigated whether stromal cell-derived factor (SDF)-1α expression correlates with lymph node metastasis in patients with EGC by immunohistochemically examining the expression of SDF-1α in 138 archival tissue specimens of EGC. Of these specimens, 59 (42.8%) and 79 (57.2%) were grouped into SDF-1α-positive and SDF-1α-negative groups, respectively. No significant differences existed with respect to age, gender, tumor location, proportion of tumors >20 mm in size, macroscopic type, depth of invasion or histology between the SDF-1α-positive and -negative groups. However, the SDF-1α-positive group was significantly correlated with lymphovascular invasion and lymph node metastasis. Results of the univariate analyses indicated that lymphovascular invasion, undifferentiated histology and SDF-1α positivity were statistically significant risk factors affecting lymph node metastasis in patients with EGC. Multivariate analyses showed that lymphovascular invasion [hazard ratio (HR), 8.595; 95% confidence interval (CI), 1.694-43.595; P=0.009], undifferentiated histology (HR, 2.965; 95% CI, 1.037-8.471; P=0.043) and SDF-1α positivity (HR, 2.108; 95% CI, 1.316-10.135; P=0.013) were independent risk factors predicting lymph node metastasis in EGC. In conclusion, these results suggest that SDF-1α expression in tumor cells is a predictive marker of lymph node metastasis in EGC.     

乙酰肝素酶与大肠癌浸润、转移和血管生成的相关性

 目的 探讨乙酰肝素酶与大肠癌浸润、转移和血管生成之间的关系。方法 应用原位杂交方法检测乙酰肝素酶mRNA在95例大肠癌组织中的定位及表达。并用免疫组化方法对全部标本进行CDl05染色，记数肿瘤微血管密度（microvessel density，MVD），分析乙酰肝素酶mRNA表达与大肠癌浸润、转移和MVD之间的关系。结果 95例大肠癌组织中，乙酰肝素酶mRNA阳性表达49例（51．57％），MVD平均值为（72．1±20．6）；阴性表达46例（48．42％），MVD平均值为（41．3±12．4），差异有统计学意义（P〈0．01）。乙酰肝素酶tuRNA表达与大肠癌组织浸润深度、淋巴结转移及MVD有关（P〈0．05）。结论 乙酰肝素酶可促进大肠癌的浸润、转移和血管生成，可作为反映大肠癌生物学行为的客观指标。     

乙酰肝素酶mRNA在大肠癌中的表达及意义

目的:探讨乙酰肝素酶在大肠癌中的表达及意义.方法:应用原位杂交方法检测乙酰肝素酶mRNA在45例大肠癌组织中的定位及表达.结果:45例大肠癌组织中,乙酰肝素酶mRNA阳性表达22例(48.88%).26例大肠癌伴淋巴结转移者,其原发灶内乙酰肝素酶mRNA表达明显高于无转移组,有显著差异(P＜0.01).乙酰肝素酶mRNA表达与大肠癌组织浸润深度、淋巴结转移有关.结论:乙酰肝素酶可能在大肠癌的生长、浸润和转移中起一定的作用.     

Clinicopathological variables associated with lymph node metastasis in submucosal invasive gastric cancer

Background We aimed to elucidate clinicopathological variables associated with lymph node metastasis of submucosal invasive gastric cancer. Methods Specimens were surgically resected from 201 patients who had primary submucosal gastric cancer. We studied 39 consecutive patients with lymph node metastasis and 162 patients without lymph node metastasis. We compared the following clinicopathological characteristics of the patients in relation to lymph node metastasis: age, sex, tumor size, histology, extent of submucosal invasion, lymphatic and venous invasion, and ulceration of the tumor. Submucosal invasion was divided subjectively into sm1, sm2, and sm3 (representing invasion of the upper-, middle-, and lower-third of the submucosa, respectively). We also studied the relationship between lymph node metastasis of submucosal gastric cancer and immunohistochemistry for p53, Ki67, vascular endothelial growth factor (VEGF), α-fetoprotein, sLe^a, and dendritic cells (DCs). Results In terms of conventional pathological factors, lymph node metastasis in submucosal gastric cancer was related to tumor size (P = 0.002), depth of submucosal invasion (P = 0.001), lymphatic invasion (P < 0.0001), and venous invasion (P = 0.012). Lymph node metastasis in sm1 gastric cancer was significantly related to VEGF expression (P = 0.047). Also, lymph node metastasis in sm3 gastric cancer was significantly correlated with DC expression (P = 0.016). Multivariate analysis showed that tumor size, tumor invasion depth in the submucosal layer, and lymphatic invasion were independent predictors of nodal metastasis in submucosal gastric cancer. Conclusion Conventional pathological factors, such as tumor size, depth of submucosal invasion, and lymphatic invasion, have a significant influence on lymph node metastasis. VEGF expression and DC expression may be helpful predictors of lymph node metastasis in patients with sm1 and sm3 gastric cancer, respectively.     

肝素酶在大肠癌转移中的作用

目的探讨乙酰肝素酶在大肠癌中的表达搜意义。方法应用原位杂交方法检测乙酰肝素酶mRNA在60例大肠癌组织中的定位及表达。结果60例大肠癌组织中,乙酰肝素酶mRNA阳性表达31例（51．66％）。34例大肠癌伴淋巴结转移者,其原发灶内乙酰肝素酶mRNA表达明显高于无转移组,差异有统计学意义（P〈0．01）。乙酰肝素酶mRNA表达与大肠癌组织浸润深度、淋巴结转移有关。结论乙酰肝素酶可能在大肠癌的生长、浸润和转移中起一定作用。     

乙酰肝素酶、E-cadherin、N-cadherin和vimentin蛋白在胃癌中的表达及其意义

目的： 探讨人胃癌组织中乙酰肝素酶（HPA）、上皮标志物E-cadherin、间质标志物N-cadherin和vimentin蛋白的表达及其与人胃癌临床病理指标的关系,以及HPA与E-cadherin、N-cadherin、vimentin蛋白之间的关系。方法： 应用免疫组织化学方法检测91例人胃癌组织中HPA、E-cadherin、N-cadherin和vimentin蛋白表达情况;采用卡方检验,检测这几种蛋白阳性表达率与人胃癌不同病理指标的关系;同时采用Spearman等级相关分析HPA与E-cadherin、N-cadherin、vimentin蛋白之间的关系。结果： 人胃癌组织中HPA、E-cadherin、N-cadherin和vimentin蛋白阳性表达率为75.82%、51.65%、54.95%和23.08%。91例人胃癌组织中HPA、E-cadherin、N-cadherin和vimentin蛋白的阳性表达率与胃癌患者年龄、性别、胃癌大小均无明显相关（P > 0.05）,而与人胃癌发生部位、分化程度和有无淋巴结转移、侵袭程度有关（P < 0.05）。HPA、N-cadherin和vimentin蛋白在贲门部阳性表达率明显高于胃体、幽门及胃窦胃癌;低分化者、有淋巴结转移者和胃癌侵袭深处这3种蛋白阳性表达率明显高于高分化者、无淋巴结转移者和胃癌起始部位;E-cadherin蛋白在幽门及胃窦部胃癌阳性表达率明显高于贲门和胃体胃癌;高中分化者、无淋巴结转移者明显高于低分化者和有淋巴结转移者。E-cadherin蛋白阳性表达率在侵袭深处明显低于起始部位。经Spearman等级相关分析显示,人胃癌组织中HPA与E-cadherin蛋白的阳性表达率呈负相关（r=-0.341,P < 0.05）;而与N-cadherin（r=0.366,P < 0.05）和vimentin（r=0.284,P < 0.05）蛋白阳性表达率呈正相关。结论： 人胃癌组织中HPA、N-cadherin和vimentin蛋白在低分化者、有淋巴结转移者和胃癌侵袭深处高表达;E-cadherin蛋白在高中分化胃癌,无淋巴结转移者和起始部位高表达。HPA与N-cadherin、vimentin蛋白阳性表达率呈正相关,HPA与E-cadherin蛋白的阳性表达率呈负相关,可见HPA蛋白与间质标志物N-cadherin和vimentin蛋白表达增强有关,而与上皮标志物E-cadherin蛋白缺失或减少有关,因此HPA可能诱导人胃癌组织发生上皮间质转化。     

Prognostic Value of PLCE1 Expression in Upper Gastrointestinal Cancer: a Systematic Review and Meta-analysis

Background: A number of studies have identified a shared susceptibility locus in phospholipase C epsilon 1(PLCE1) for esophageal squamous cell carcinoma (ESCC) and gastric cardia adenocarcinomas (GCA). However,the results of PLCE1 expression in esophageal and gastric cancer remain inconsistent and controversial.Moreover, the effects on clinicopathological features remain undetermined. This study aimed to provide aprecise quantification of the association between PLCE1 expression and the risk of ESCC and GCA throughmeta-analysis. Materials and Methods: Eligible studies were identified from PubMed, Wanfang Data, ISI Web ofScience, and the Chinese National Knowledge Infrastructure databases. Using RevMan5.2 software, pooled oddsratios (ORs) with 95% confidence intervals (CIs) were employed to assess the association of PLCE1 expressionwith clinicopathological features relative to ESCC or GCA. Results: Seven articles were identified, including761 esophageal and gastric cancer cases and 457 controls. Overall, we determined that PLCE1 expression wasassociated with tumor progression in both esophageal cancers (pooled OR=5.93; 95%CI=3.86 to 9.11) and gastriccancers (pooled OR=9.73; 95%CI=6.46 to 14.7). Moreover, invasion depth (pooled OR=3.62; 95%CI=2.30 to5.70) and lymph node metastasis (pooled OR=4.21; 95%CI=2.69 to 6.59) were linked with PLCE1 expressionin gastric cancer. However, no significant associations were determined between PLCE1 overexpression andthe histologic grade, invasion depth, and lymph node metastasis in esophageal cancer. Conclusions: Our metaanalysisresults indicated that upregulated PLCE1 is significantly associated with an increased risk of tumorprogression in ESCC and GCA. Therefore, PLCE1 expression can be appropriately regarded as a promisingbiomarker for ESCC and GCA patients.     

The prognosis and clinicopathology of CXCR4 in gastric cancer patients: a meta-analysis

The chemokine receptor 4 (CXCR4) has been widely investigated in diagnosis and prognosis of gastric cancer (GC). However, the impact of CXCR4 on GC patients remains controversial; Here, we conducted a meta-analysis to obtain the precise role of CXCR4 in GC prognosis and clinicopathology. Thirteen published studies with a total of 1,936 patients were included. Original data included the hazard ratio (HR) of overall survival (OS) and odds ratio (OR) in GC patients. We combined HR/OR with 95 % confidence interval (CI) to estimate the hazard. In this study, OS was significantly related to CXCR4 expression, with the HR 2.63 (95 % CI 1.69–4.09; p?<?0.0001), and a significant correlation was also revealed between CXCR4 expression and stage (I?+?II, +) (OR 0.52, 95 % CI 0.32–0.83; p?=?0.007), depth of invasion (T1/T2, +) (OR 0.44, 95 % CI 0.27–0.73; p?=?0.001), lymph node metastasis (LN, +) (OR 2.30, 95 % CI 1.57–3.36; p?<?0.0001), as well as vascular invasion (vas.inv, +) (OR 0.72, 95 % CI 0.53–0.98; p?=?0.04). Heterogeneity was observed among the included studies with OS (I ²?=?51 %), stage (I ²?=?78 %), depth of invasion (I ²?=?74 %), lymph node metastasis (I ²?=?64 %), and histology differentiation (I ²?=?79 %). No publication bias was observed. In conclusion, this meta-analysis showed CXCR4 expression indicates poor prognosis in GC patients with advanced stage or deep invasion in GC tissues, which also implied lymph node metastasis and vascular invasion. Thus, CXCR4 could help predict patient prognosis and guide clinical diagnosis and treatment.     

INPP4B mRNA 及蛋白在胃癌患者外周血中的表达及意义

目的：探讨 INPP4B mRNA 及蛋白在胃癌患者外周血中的表达水平,并分析其表达水平与临床病理参数（TNM分期、淋巴结转移和浸润深度）的关系。方法：应用实时荧光定量 PCR（QRT －PCR）及酶联免疫吸附实验（ELISA）测定50例胃癌患者及30例健康志愿者外周血 INPP4B mRNA 及蛋白的表达水平。结果：胃癌患者外周血中 INPP4B mRNA 比健康志愿者外周血中 INPP4B mRNA 的表达水平显著下降（P ＜0．05）,IN-PP4B 蛋白在胃癌患者外周血中的浓度[（845．118±293．560）ng／L],显著低于健康志愿者外周血中的浓度[（2089．204±603．829）ng／L]（P ＜0．05）。INPP4B mRNA 及蛋白的表达水平在胃癌外周血中与 TNM分期、淋巴结转移和浸润深度相关（P ＜0．05）。结论：外周血中 INPP4B mRNA 及蛋白的表达与胃癌关系密切,可作为反映胃癌发生、发展过程的有效分子指标。     

Risk of lymph node metastasis and prognostic outcome in early gastric cancer patients with mixed histologic type

BackgroundWhether early gastric cancer with mixed histologic type should be considered for endoscopic submucosal dissection (ESD) remains controversial. The objective of this study was to evaluate the risk of lymph node metastasis (LNM) and prognostic significance for early gastric cancer with mixed histologic type.MethodsWe retrospectively reviewed clinicopathologic and survival data of 302 patients who underwent surgical resection for early gastric cancer. Based on the histologic components, all patients were classified as pure differentiated type, pure undifferentiated type and mixed histologic type. The prognostic differences between different types were compared and predictive factors for LNM were evaluated.ResultsHistopathologically, the proportion of mixed histologic type was 12.3% in early gastric cancer. In terms of LNM, mixed histologic type had a more frequent incidence than pure differentiated type (32.4% vs 11.1%, P < 0.01). However, there was no significant difference between mixed type and pure undifferentiated type for LNM (32.4% vs 21.1%, P = 0.139). Multivariate analysis revealed that tumor size >2 cm (odds ratio [OR]: 2.153, 95% confidence interval [CI]: 1.113-4.164, P < 0.05), submucosal invasion (OR: 3.881, 95%CI: 1.832-8.222, P < 0.001), lymphovascular invasion (OR: 8.797, 95% CI: 2.643-29.277, P < 0.001), undifferentiated type (OR: 3.146, 95% CI: 1.352-7.320, P < 0.01), and mixed histologic type (OR: 3.635, 95% CI: 1.272-10.390, P < 0.05) were independent risk factors for LNM in early gastric cancer patients. However, mixed histologic type did not affect the survival outcome of these patients (hazard ratio: 0.629, 95% CI: 0.074-5.311, P > 0.05).ConclusionMixed histologic type was an independent risk factor for lymph node metastasis in early gastric cancer patients. The decisions regarding endoscopic submucosal dissection for mixed histologic type should be carefully considered.     

早期胃癌组织中上皮钙粘蛋白表达与淋巴结微转移及临床病理的关系

背景与目的:早期胃癌淋巴结微转移问题日益受到关注,胞浆角蛋白(cytokeratin,CK)染色是识别上皮源性恶性肿瘤细胞的重要方法,本研究拟探讨早期胃癌原发灶上皮钙粘蛋白(epithelial cadherin,E-cad)的表达情况与淋巴结内出现微转移之间的关系及临床意义.方法:用免疫组织化学染色的方法对162例早期胃癌患者的4 522枚淋巴结进行苏木精-伊红(HE)和胞浆角蛋白(cytokeratin,CK)染色,并对其中135例患者的原发灶切片进行E-cad染色,结合临床病理资料和随访结果进行分析.结果:HE染色发现的淋巴结转移率为6.8%(11/162),而CK染色发现的淋巴结转移率为26.5%(43/162),二者差异有统计学意义(P＜0.001).在151例HE染色未见淋巴结转移的患者中通过CK染色发现了32例(21.2%)有淋巴结微转移,且淋巴结微转移多见于原发灶直径大于1.0 cm,组织分化不良,肿瘤浸润较深的(如浸及粘膜下层),淋巴管和血管受累,以及E-cad低表达标本(P＜0.05).原发灶E-cad的低表达率为57.0%(77/135),与淋巴结出现微转移有密切关系,有淋巴结微转移患者的5年生存率比没有微转移者明显低(P＜0.01).结论:肿瘤直径大于1.0 cm,组织分化不良,较深的浸润,淋巴管或血管受累,以及E-cad低表达是早期胃癌患者出现淋巴结转移的高危因素.