腹膜转移胃癌的临床病理特征和相关机制研究

目的:探讨发生腹膜转移胃癌的临床病理学特征和胃癌发生腹膜转移的机制.方法:收集164例临床资料和随访资料完整的胃癌患者,将其分成腹膜转移组41例和无腹膜转移组123例,对2组一般资料进行比较,并行缺氧诱导因子-1 a(HIF-1a)、黏着斑激酶(FAK)和基质金属蛋白酶-9( MMP-9)的免疫组化染色.结果:2组Lauren分型、浸润深度及TNM分期差异有统计学意义(P＜0.01),其中弥漫型胃癌(DGC)和肠型胃癌(IGC)患者的腹膜转移率(29.37％vs10.53％)差异亦有统计学意义(P＜0.01).Kaplan-Meier生存分析显示腹膜转移组的生存率低于无腹膜转移组(P＜0.01),Cox回归模型显示TNM分期和腹膜转移是影响胃癌患者生存率的危险因素.腹膜转移组HIF-la、FAK和MMP-9的表达均高于无腹膜转移组(P＜0.05或P＜0.01).结论:缺氧可能在胃癌的腹膜转移中发挥了重要的作用.

The Clinicopathologic Significance and Mechanism of Peritoneal Metastasis of Gastric Cancer

Objective: To investigate the clinicopathologic significance of peritoneal metastasis(PM) of gastric cancer,and the mechanism thereof.Methods:One hundred and sixty-four patients with gastric cancer were divided into two groups,PM-positive group(n=41) and PM-negative group(n=123).The detailed follow-up data were collected and compared be tween two groups.Immunohistochemical staining of hypoxia-inducible factor-1 a(HIF-1a),focal adhesion kinase(FAK) and matrix metalloproteinase-9(MMP-9) were performed in all samples.Results: There were significant differences in Lauren type,invasive depth and TNM stage between two groups(P < 0.01).There was a significant difference in rate for peritoneal metastasis between diffuse-type gastric cancer(DGC) group and itestinal-type gastric cancer(IGC) group(29.37% vs 10.53%,P< 0.01).The Kaplan-Meier survival analysis showed that the survival duration was significantly shorter in PM-pos itive group than that of PM-negative group(P < 0.01).Cox proportional hazards model indicated that the PM and TNM stage were independent predictors of poor prognosis for gastric cancer.The immunohistochemical expressions of HIF-1a,FAK and MMP-9 were all higher in PM-positive group than those in PM-negative group(P< 0.05 orP< 0.01l).Conclusion: Hypoxia might play a role in the formation of PM in gastric cancer.