胃癌螺旋CT术前分期与PTEN、COX-2表达的相关性分析

目的研究多层螺旋CT(MSCT)及PTEN、COX-2相结合对胃癌进行术前诊断及TNM分期的价值,探讨胃癌MSCT征象与PTEN、COX-2表达的关系。方法80例胃癌术前MSCT检查行TNM分期;32例胃癌切除组织行PTEN、COX-2表达分析。并与病理结果对照。结果MSCT对胃癌TNM总体判断准确率为74%。对胃癌T分期的总体判断准确率为74%。其中,T1期67%,T2期61%,T3期84%和T4期88%。MSCT对N分期的判断准确率为78%。其中,N090%,N171%和N268%。MSCT对远处转移判断准确率为94%。PTEN蛋白的表达与胃癌的大小无关(P>0.05)。而与胃癌的浸润深度、淋巴结转移、TNM分期有关(P<0.05)。COX-2蛋白的表达与有无淋巴结转移无关(P>0.05)。而与肿瘤的浸润深度、大小、TNM分期有关(P<0.05)。结论动态增强MSCT薄层扫描可较准确的显示正常胃壁结构及胃癌侵犯胃壁的深度,通过其在不同时相中的强化特点显示病变累及的范围,同时可反映淋巴结转移情况,并对远处脏器的转移和播散做出较为准确的TNM分期。并与胃癌PTEN、COX-2表达有明显相关,两者结合有利于提高胃癌分期诊断的准确率。

Correlation study between spiral CT in preoperative staging and PTEN or COX-2 expression in gastric carcinoma

Objective To investigate combined application of multi-layer spiral computed tomography(MSCT) and PTEN or COX-2 detection in preoperative diagnosis and TNM staging in gastric carcinoma.Methods Eighty cases of gastric carcinoma were enrolled to undergo MSCT for TNM staging referred to their postoperative pathological results,and PTEN and COX-2 were detected in intraoperatively resected carcinoma samples in 32 cases.Results By MSCT imaging,the overall accuracy achieved in TMN staging determination of those cases by MSCT was 74%,with in T staging reaching 74%,67% in T1,61% in T2,84% in T3,and 88% in T4,respectively;the accuracy in N staging was 79%,90% in N0,71% in N1,and 68% in N2,respectively;the accuracy in distant metastasis was 94%.According to our data,PTEN expression was not related to the size of the mass(P>0.05) but correlated with the depth of infiltration,lymph node metastasis and TNM staging(P<0.05);and COX-2 expression was not related to lymph node metastasis(P>0.05) but correlated with the depth of infiltration,the size of the mass and TNM staging(P<0.05).Conclusion Structure of normal gastric wall and depth of its infiltration by carcinoma could be clearly revealed in dynamic MSCT-thin-layer-imaging,and lymphatic involvement and further adjacent invasion or distant dissemination could also be shown during their enhancement in different phases.Thus TNM staging could be accurately made by MSCT imaging.Their relation to PTEN or COX-2 expression implied that combined application of both to improve the accuracy of diagnosis and staging in gastric carcinoma was reasonable.