胃肝样腺癌中Glypican-3的表达及临床病理特征的研究

目的 探讨Glypican-3（GPC3）在胃肝样腺癌（HAC）组织中的表达及与临床病理特点和预后之间的关系.方法 回顾性分析2008年～2013年我院确诊的21例胃HAC患者的临床资料,采用免疫组织化学染色的方法检测GPC3、甲胎蛋白（AFP）及肝细胞石蜡单克隆抗体（HepPar-1）在21例胃HAC患者及42例普通型胃腺癌（GC）患者中的表达,分析GPC3与临床病理特点的关系及其与预后的相关性.结果 GPC3、AFP及HepPar-1在胃HAC中的表达明显高于GC,分别为85.7％（18/21）和14.3％（6/42）、48.6％（10/21）和2.4％ （1/42）及57.1％（12/21）和19.0％ （8/42）.在胃HAC患者中,GPC3强阳性比例为66.7％（14/21）,远高于AFP的33.3％（7/21）及HepPar-1的38.1％ （8/21）.GPC3诊断胃HAC的敏感性高于AFP及HepPar-1.GPC3的表达与癌组织脉管侵犯及血清AFP水平升高显著相关（P＜0.05）,与患者的性别、年龄、肿瘤的大小、部位、pTMN分期、是否合并其他类型腺癌、肿瘤分化程度及血清CA199的水平无明显相关（P＞0.05）.Kaplan-Meier分析显示,GPC3在胃HAC中的过表达与手术后的生存时间呈负相关（P＜0.01）.结论 GPC3可用于辅助诊断胃HAC,其过表达是预后不良的相关因素.

The expression of Glypican-3 in hepatoid adenocarcinoma of stomach and correlation with the clinicopathological features

Objective To explore the expression of Glypican（GPC3） in the hepatoid adenocarcinoma（HAC） of stomach,and its correlation with the clinicopathological parameters.Methods Twentyone cases with HAC of the stomach between 2008 and 2013 were reviewed.The expression of glypican （GPC） 3,AFP and HepParl were examined in HAC by immunohistochemistry,and the correlation between the expression of GPC3 and clinicopathological parameters or prognosis.Results The expressions of GPC3,AFP and HepPar-1 were higher in HAC than those in gastric adenocarcinoma（GC）85.7% （18/21） vs.14.3% （6/42） 、48.6% （10/21） vs.2.4% （1/42） and 57.1% （12/21） vs.19.0% （8/42） respectively].Diffuse positive immunoreactivity of GPC3 was detected stronger than those of AFP or HepPar-1 66.7%（14/42） vs.33.3% （7/21） ; 66.7% （14/42） vs.38.1% （8/21）].The specificity of HAC diagnosis was higher than those of AFP or HepPar-1.Positive immunoreactivity of GPC3 was correlated with invasion of vessels in cancer tissue and increased level of serum AFP（P 〈 0.05）,but not correlated with age,gender,histological grade of differentiation,tumor location,pTNM stage or the level of serum CA19-9 （P 〉 0.05）.Kaplan-Meier analysis showed that survival time after operation was significantly correlated with up-regulated expression of GPC3 （Log-rankTest P 〈 0.01）.Conclusion The immunostaining of GPC3 has a much higher sensitivity than those of AFP or HepPar-1 in the diagnosis of HAC.Up-regulated expression of GPC3 predicts a poor prognosis of HAC.