胃癌细胞功能分化表型与侵袭转移的关系

目的 建立一种胃癌细胞功能分类新方法，探讨胃癌细胞功能分化表型与侵袭转移的关系。方法 按癌细胞功能分化方向和状态，将361例胃癌分为5型。结果（1）吸收功能分化型（AFDT）：82例，占22．7％，13．6％（9／66）男性伴肝脏转移。（2）黏液分泌功能分化型（MSFDT）：54例，占15．0％，有98．1％（53例）病变侵透浆膜。（3）吸收－黏液产生功能双向分化型（AMPFDT）：180例，占49．9％，女性占34．4％，雌激素受体表达率为71．7％，均明显高于其他型；19．4％女婿姓伴卵巢转移。（4）特殊功能分化型（SFDT）：13例，占3．6％，69．2％（9／13）属弥漫性神经内分泌系统来源。（5）无功能分化型（NFDT）：32例，占8．9％，59．4％（19例）伴淋巴结转移。5组术后5年生存率分别为58．5％、28．6％、24．7％、60．0％和28．1％。结论 胃癌细胞功能分类方法可为判断不同类型胃癌的生物学行为及侵袭转移特点提供有益信息，癌细胞功能分化表型与其相应的基因型以及胃癌生物学行为的内在联系有待深入探讨。

Correlation between cell-functional differentiation phenotype and pathobiological behavior of gastric carcinoma

Objective To demonstrate the correlation between cell functional differentiation features and invasion, metastasis of gastric carcinoma (GC) by establishing a new classification based on cell functional differentiation. Methods According to the direction and condition of cell functional differentiation, 361 gastric carcinomas were divided into five types to show their respective pathobiological behavior. Results (1) Absorptive functional differentiation type (AFDT): 22.7%(82). 13.6% of the male patients developed liver metastasis, (2) Mucin secreting functional differentiation type (MSFDT): 15%(54). 98.1% of GC showed serosa invasion, (3) Absorptive and mucin producing double functional differentiation type (AMPFDT): 49.9%(180). Women infliction (34.4%) and estrogen receptor (ER) expression (71.7%) in this group were more common than in the other types ( P <0.01). 19.4% of these female patients were complicated with ovarian metastasis, (4) Specific functional differentiation type (SFDT): 3.6%(13). 69.2% of these tumors derived from (high) A (amine content) (high) P (precursor) U (uptake from the ambient medium) (presence of) D (decarboxylase) (APUD) system and (5) non functional differentiation type (NFDT): 8.9%(32). 59.4% developed lymphatic metastasis. The 5 year survival rates of these types were 58.5%, 28.6%, 24.7%, 60.0% and 28.1%, respectively. Conclusion This new cell functional classification of gastric cancer is helpful by indicating their pathobiological behavior and characteristics of invasion and metastasis. Further study is needed to clarify the correlation between cell functional differentiation phenotypes and their relevant genotypes as well as the inherent relationship between the biological behavior.