大肠癌及癌旁内分泌细胞的表达意义

Expression of endocrine cells in colorectal cancer and its adjacent mucosa

目的探讨内分泌细胞（ＥＣ）在大肠癌及癌旁的表达意义．方法应用ＬＳＡＢ免疫组化法，对１１７例大肠癌及８５例癌旁粘膜中嗜铬蛋白Ａ（ＣＧＡ）及几种激素进行检测，１３例大肠癌行电镜观察．结果ＥＣ阳性大肠癌４６例（３９３％），检测到一种以上激素６９２％（２７／３９），癌旁粘膜ＥＣ数高于正常肠粘膜．电镜观察８例有含内分泌颗粒的癌性ＥＣ．在中低分化癌中ＥＣ（＋＋）的表达（２５５％）高于高分化癌（６９％）（χ２＝７５４，Ｐ＜００５），含有ＥＣ的大肠癌淋巴结转移的发生率（６８０％）高于不含ＥＣ者（４３７％）（χ２＝６２３，Ｐ＜００５），且预后不良；５ＨＴ，βＨＣＧ，Ｇｌｕ，Ｇａｓ阳性癌分化及预后较差（Ｐ＞００５）．结论含ＥＣ的大肠癌具有更恶性的生物学行为，可能与ＥＣ中某些激素，通过旁分泌等途径促进肿瘤的生长转移有关，癌旁ＥＣ增生与周围肿瘤生长有关．

AIM To study the expression and clinical significance of endocrine cells (EC) in colorectal cancer (CC) and its adjacent mucosa (MAC). METHODS Chromograin A (CGA) and five kinds (5 HT, β HCG,Gas,Glu and SS) of hormones in 117 CC cases and 85 MAC cases were detected by LSAB immunohistochemistry. Thirteen cases of CC were observed under electron microscope. RESULTS CGA positive cells (EC) were found in 46 CC cases (39 3%). In 69 2%(27/39) more than one hormone were expressed . The number of EC in MAC was higher than that in normal mucosa. Cancer cells containing endocrine granules were found in 8 CC cases under electron microscopy. The incidence of EC (++) in CC with moderate and poor differentiation (25 5%) was higher than in CC with high differentiation(6.9%) (χ 2=7 54, P <0 05). The lymph node metastasis rate in the EC positive CC (68.0%) was higher than EC negative CC (43 7%) (χ 2=6 23, P <0 05). CC containing EC gave a shorter survival. 5 HT, β HCG,Glu and Gas occurred more often in tumors with poor differentiation, and had poorer prognosis ( P >0 05). CONCLUSION EC positive CC has worse biologic behaviour. Some hormones secreted by EC could partly account for the growth and metastasis of CC by paracrine. EC hyperplasia of MAC is related with growth of CC.