CDX2在胃癌及癌前病变组织中的表达及其临床意义

EXPRESSION AND SIGNIFICANCE OF CDX2 IN GASTRIC CARCINOMA AND PRECANCEROUS LESIONS

目的研究CDX2在胃癌及癌前病变组织中的表达及其与临床病理因素之间的关系。方法采用免疫组织化学S-P法检测CDX2在胃癌及癌前病变组织中的表达,采用阿新兰/过碘酸雪夫氏染色(AB/PAS)和高铁二铵/阿新兰(HID/AB)染色对胃黏膜肠化生进行分型。结果 (1)CDX2在正常胃黏膜组织、慢性浅表性胃炎中不表达,CDX2在肠化、异型增生及胃癌中的阳性率(81.7%、50%、48.2%)均明显高于正常胃黏膜组织(P<0.05),在肠化组织中的表达明显高于异型增生和胃癌(P<0.05),在异型增生和胃癌中的阳性率差异无显著性(P>0.05)。CDX2的表达与肠化的分型和异型增生的分级之间均无关系。(2)CDX2在肠型胃癌中的阳性率(67.4%)明显高于弥漫型和混合型胃癌(25.7%、42.9%);CDX2的表达与胃癌分化程度呈正相关,而与淋巴结转移和临床分期呈负相关,差异均有统计学意义。CDX2阳性表达组的五年生存率明显高于阴性表达组(P=0.038);多种变量对胃癌患者术后生存时间影响的分析显示,CDX2的表达和淋巴结转移是影响胃癌预后的独立因素(P<0.05)。结论 CDX2可能在胃粘膜肠化生的发生及胃癌的发生发展中起重要作用,可作为胃癌诊断、判断胃癌的恶性程度及患者预后的有用指标。

Objective To investigate the expression and significance of caudal-related homeobox transcription factor（CDX2） in gastric carcinoma（GC） and precancerous lesions,and to examine the relationship between CDX2 expression and clinical pathological characteristics of GC.Methods The expressions of CDX2 in GC,precancerous lesions and normal gastric mucosa were detected by immunohistochemistry（S-P method）.HE staining,alcian blue-periodic acid-Schiff（AB/PAS） and high iron diamine/alcian blue（HID/AB） staining were used to classify intestinal metaplasia（IM） and GC.Results CDX2 was not detected in normal gastric mucosa and chronic superficial gastritis.The positive rates of CDX2 in IM,dysplasia and GC（81.7%,50%,48.2%） were higher than that of normal mucosa（P0.05）.The positive rate of CDX2 in IM was much higher than that of dysplasia and GC（P0.05）.There was no significant difference between dysplasia and carcinoma.There was no relationship between CDX2 expression and the classification of IM or the degree of dysplasia.The expression of CDX2 was significantly higher in intestinal-type carcinoma（67.4%） than in diffuse and mixed type carcinoma（25.7%,42.9%,P0.05）.Positive expression of CDX2 was mainly found in moderately to well differentiated GC.There was a negative association between nuclear CDX2 expression and lymph node metastasis and TNM stage of GC（P0.05）.The patients with CDX2-positive expression showed higher survival rate than those with CDX2-negative expression（P=0.038）.Multivariate analysis revealed that the expression of CDX2 and lymph node metastasis were independent prognostic indicators of GC（P0.05）.Conclusion These findings suggest that the abnormal expression of CDX2 plays an important role in the development and progression of intestinal metaplasia and gastric carcinoma.CDX2 expression in carcinoma may serve as a useful marker to diagnose,to judge the degree of malignancy and to predict the prognosis of patients.