早期胃癌临床病理特点及免疫表型分析

Clinicopathological Characteristics and Immunophenotype of Early Gastric Cancer

目的探讨早期胃癌的临床病理特点及免疫组织化学特点。方法由胃镜活检标本病理组织学观察,再经手术切除证实的47例早期胃癌,采用免疫组化S-P法对p21、p53、PTEN、APC等9种相关基因蛋白进行了检测。结果早期胃癌肉眼形态:Ⅰ型隆起型占4.3%(2/47);Ⅱ型平坦型占72.3%(34/47);Ⅲ型凹陷型占23.4%(11/47)。组织病理学类型:乳头状腺癌14.9%(7/47),管状腺癌27.7%(13/47),黏液腺癌10.6%(5/47),低分化腺癌17.2%(8/47),印戒细胞癌25.3%(12/47)和未分化癌4.3%(2/47)。早期胃癌根据厚度和大小分为6种,其中小黏膜癌10.6%(5/47),浅表黏膜癌34.0%(16/47),小黏膜下层癌40.4%(19/47),浅表黏膜下层癌14.9%(7/47),穿透型Pen A型癌4.3%(2/47),穿透型Pen B型癌10.6%(5/47)。免疫表型:胃癌相关糖类抗原CA50、CA19-9、CA242阳性表达均在70%以上;胃癌相关抑癌基因蛋白p16、p53、APC、PTEN阳性表达分别为42.6%、48.9%、51.1%和53.2%;肿瘤抑制因子p21阳性表达40.4%;凋亡抑制基因Survivin 59.6%;细胞增殖指数Ki-67<40%。随访结果:47例患者随访3～108个月,健康状况良好。结论早期胃癌预后好,组织病理学诊断须联合免疫表型,以提高早期诊断率,降低误诊率。

Objective To investigate clinicopathological characteristics and immunophenotypic features of early gastric cancer.Methods p21,p53,PTEN,APC and other 9 related genes were detected by SP immunohistochemistry in 47 cases of early gastric cancer.Results Macroscopically,type Ⅰ（protruding） accounted for 4.3%（2/47）,type Ⅱ（flat） accounted for 72.3%（34/47）,and type Ⅲ（depressed） accounted for 23.4%（11/47）.Histological types included papillary adenocarcinoma in 14.9%（7/47）,tubular adenocarcinoma in 27.7%（13/47）,mucinous adenocarcinoma in 10.6%（5/47）,poorly differentiated adenocarcinoma in 17.2%（8/47）,signet-ring cell carcinoma in 25.3%（12/47） and the undifferentiated carcinoma in 4.3%（2/47）.Early gastric cancer were divided into 6 types based on its thickness and size,including small mucosal cancer（10.6%,5/47）,superficial mucosal cancer（34.0%,16/47）,small submucosal cancer（40.4%,19/47）,superficial submucosa cancer（14.9%,7/47）,penetrated Pen A type cancer（4.3%,2/ 47）,and penetrated Pen B-type cancer（10.6%,5/47）.Immunophenotype：The expression of gastric cancer related carbohydrate antigen of CA50,CA19-9 and CA242 were more than 70%.The expression of gastric cancer related tumor suppressor gene of p16,p53,APC,PTEN was 42.6%,48.9%,51.1% and 53.2%,respectively.The expression of tumor suppressor of p21 was 40.4%,The expression of inhibitor of apoptosis gene of survivin was 59.6%,cell proliferation index of Ki-67 was 40%.Follow-up results：47 patients were followed from 3 to 108 months,all were in good health.Conclusion Early gastric cancer has a good prognosis,its correct histopathological diagnosis must combined with immunophenotype to improve early diagnosis rate and reduce misdiagnosis rate.