浆膜浸润胃癌中肝细胞生长因子、转录因子SP1、血管内皮生长因子和CD34表达与胃癌细胞脱落及预后关系

Expression of hepatocyte growth factor, transcription factor SP1, vascular endothelial growth factor and CD34 in serosa-infiltrative gastric cancer and their relations with defluxion of gastric cancer cell and prognosis

目的观察肝细胞生长因子（HGF）、转录因子SP1、血管内皮生长因子（VEGF）及CD34在浆膜浸润胃癌（T3）中表达及其与病理生物学行为关系，同时探讨胃癌细胞腹腔脱落的分子基础及其对预后的影响。方法采用大剂量生理盐水（1000ml）腹腔灌洗方法，选择性收集2007年4月至12月80例浆膜浸润胃癌（T3）手术患者腹腔冲洗液，进行细胞学检测和细胞角蛋白18（CK18）免疫化学检测寻找癌细胞；运用免疫组织化学方法，对石蜡包埋的浆膜浸润胃癌（1、3）癌组织中HGF、SP1、VEGF和CD34[以微血管密度（MVD）值表示]进行检测；同时进行严密随访。结果患者腹腔冲洗液细胞学检测阳性率为63．8％（51／80），CK18免疫化学检测阳性率为75．0％（60／80）。腹腔冲洗液细胞学检测阳性病例CK18检测均为阳性，腹腔冲洗液细胞学检测阴性患者有9例CK18检测为阳性，其中6例经病理科医师会诊确定为游离癌细胞阳性，本组病例脱落细胞阳性率为71．3％（57／80）。胃癌组织中HGF、SP1和VEGF阳性率分别为57．5％、52．5％和55．0％，与MVD值的相关性具有统计学意义（P〈0．05）。HGF、SP1、VEGF和MVD值与脱落细胞阳性率等临床特征相关（P〈0．05）。经单因素分析发现HGF、SP1、VEGF和MVD值与预后相关（P〈0．05），Logistic回归分析显示HGF、SP1和VEGF是预后的独立影响因素（P〈0．05）。结论浆膜浸润胃癌（1、3）中HGF、SP1、VEGF及MVD表达与胃癌生物学行为关系密切，检测几种因子对预测胃癌细胞腹腔脱落和术后复发具有一定的参考价值。

Objective To observe the expression of hepatocyte growth factor（ HGF）, transcription factor SP1, vascular endothelial growth factor （VEGF） and CD34 （demonstrating by microvessel density, MVD） in serosa-infiltrative gastric cancer（13 ） and their relations with the pathobiological behavior of the tumor, and to investigate the molecular basis of the defluxion of gastric cancer cells in abdominal cavity and its influence on prognosis. Methods Selective collection of peritoneal lavage was obtained from 80 patients with serosa-infiltrative gastric cancer received operation from April to December in 2007. The cancer ceils were detected by using peritoneal lavage cytology （PLC） and immunochemistry of cytokeratin 18 （CK18）. Immunohistochemistry was applied to detect the HGF, SP1, VEGF and CD34 in serosa-infihrative gastric cancer tissues. The rigorous follow-up was carried out for the patients. Results The positive rate of PLC was 63.8% （51/80）, and the positive rate of immunochemistry of CK18 was 75.0% （60/80）. The positive cases in PLC were positive in immunochemistry of CK18 also, while 9 negative cases in PLC were positive with CK18, and of them 6 cases were determined positive with exfoliated cancer cells through pathological consulting. So the positive rate of exfoliated cells of this group was 71.3% （57/80）. The positive rates of HGF, SP1 and VEGF in gastric cancer tissues were 57. 5%, 52. 5% and 55.0%, respectively, and were all significantly correlated with the MVD （P 〈 0. 05 ）. HGF, SP1, VEGF and MVD were correlated with the positive rate of exfoliated cells （P 〈 0.05）. HGF, SP1, VEGF and MVD were found significantly related to prognosis on univariate analysis （ P 〈 0. 05 ）, and it was demonstrated that HGF, SP1 and VEGF were independent prognostic influential factors on Logistic regression analysis （P 〈 0.05）. Conclusions The expression of HGF, SP1, VEGF and MVD are related with the biological behaviour of serosa-infiltrative gastric cancer. The detection of these factors might be helpful in predicting the defluxion of gastric cancer cells and postoperative recurrence.