胰腺癌癌旁组织中胰腺导管上皮内瘤变的研究

目的:研究胰腺导管腺癌癌旁正常胰腺组织和合并慢性胰腺炎组织中各级PanIN的发生率及与临床病理学指标间的关系。方法:对航天中心医院和北京大学第三医院1994年1月至2006年12月间外科切除的36例胰腺导管腺癌标本进行回顾性研究,比较研究标本中癌旁正常胰腺组织和合并慢性胰腺炎组织中PanIN的发生情况,并与临床病理学指标进行相关性分析。结果:36例标本中共有13例存在PanIN病变,发生率为36.1%。其中,癌旁合并慢性胰腺炎组织PanIN的发生率(57.1%)明显高于癌旁正常胰腺组织(22.7%)(P<0.05);癌旁合并慢性胰腺炎组织中高级别PanIN发生率(35.7%)明显高于癌旁正常胰腺组织(4.5%)(P<0.05),PanIN-3仅在癌旁慢性胰腺炎组织中见到。在不同性别、不同分化程度及不同临床分期间PanIN的发生率均未见明显差异;CA199阳性组与阴性组中PanIN的发生率有明显差异(P<0.01)。CEA、CA125阳性组与阴性组PanIN的发生率无明显差异。结论:胰腺导管腺癌癌旁正常胰腺组织和癌旁合并慢性胰腺炎组织中PanIN的发生率逐渐增加,程度逐渐加重,支持慢性胰腺炎是向胰腺癌发展过程中的重要形态学改变。

Comparative Study on Feature of PanIN in the Vicinity of Pancreatic Cancer

Objective:To evaluate the features of pancreatic intraepithelial neoplasia(PanIN)in the vicinity of pancreatic ductal adenocarcinoma coexisting with normal pancreas and chronic pancreatitis tissues.Methods:Thirty-six patients of pancre- atic ductal adenocarcinoma were retrospectively analysed.Pancreatic samples,which were surgically removed,were stained with hematoxylin-eosin for histological analysis.The specimens were evaluated blind by 2 pathologists for the presence of the fol- lowing histology:normal ducts,reactive hyperplasia,PanIN-1A,PanIN-1B,PanIN-2,and PanIN-3,and adenocarcinoma.The correlationship between pancreatic intraepithelial neoplasia and clinicopathological parameters were analyzed.Results:PanIN lesions were found in 36.1%(13/36)of pancreatic samples.PanIN lesions in vicinity of pancreatic ductal adenocarcinoma co- existing with chronic pancreatitis tissues(57.1%)was significantly higher than that in the vicinity of pancreatic ductal adeno- carcinoma coexisting with normal pancreas tissues(22.7%) (P<0.05).Higher grade PanIN lesions in the vicinity of pancre- atic ductal adenocarcinoma coexisting with chronic pancreatitis tissues (35.7%),was significantly higher than that in vicinity of pancreatic ductal adenocarcinoma coexisting with normal pancreas tissues(4.5%)(P<0.05).PanIN-3 lesions were only seen in chronic pancreatitis tissues.There were no significant differences of PanIN positive rates between male and female pa- tients,among the patients with different differentiations,or different clinic stages.As for tumor biomarkers,PanIN positive rate in CA199 positive patients was higher than that in CA199 negative patients(P<0.01).No significant differences were found between CEA or CA125 negative and positive group.Conclusion:Chronic pancreatitis is an important morphological change in pancreatic cancer carcinogenesis.