胃远端癌口侧癌旁粘膜p53、p21的表达与残胃断端复发癌的关系

Relationship between the expression of p53,p21 genes in the upper gastric mucosa adjacent to the gastric carcinoma and the carcinomas on the edge of the remnant stomach

目的 探讨建立胃远端癌“分子切缘”概念的可行性。方法 应用免疫组化法对 12 2例胃远端癌切除标本 (其中 3 0例术后随访有残胃断端复发癌 )的癌周口侧粘膜的p5 3、p2 1的表达进行研究。结果 ① 60例胃癌上切端组织中复发组的p5 3、p2 1的阳性率及联合阳性表达均明显高于对照组 (P <0 0 0 5 )。② 62例胃远端癌的癌周口侧粘膜的p5 3、p2 1阳性率的变化趋势是自小弯和前 (后 )壁的近癌端向上切端逐步降低 ,并以小弯纵轴为主干向两侧逐步降低 ,其表达分布类似正态分布 ,顶峰位于小弯侧距癌肿边缘 4～ 5cm处。结论 胃远端癌上切端的p5 3、p2 1阳性表达 ,尤其是联合阳性表达与残胃断端复发癌存在显著的相关性。建立“分子切缘”概念 ,即在通常的HE染色光镜下无癌组织为阴性判定的基础上 ,应用免疫组化法检测上切端 ,以p5 3、p2

Objective The variations and the factors related with the expression of p53,p21 genes in the upper gastric mucosa adjacent to the gastric carcinoma were examined and a new concept“molecular edge of gastrotomy' was established.Methods Adequate formalin fixed paraffin embedded upper gastric mucosa of gastric carcinoma and the edge of the remnant stomach for the immunohistochemical staining of p53,p21 were obstained in 122 patients from 1980 to now with complete clinicopathological and survival data means.Results The positive rates of p53,p21 were higher in test group than in control group( P <0.005),even between“-” and “+”.The concordance rate of p53,p21 in test group were higher than in control group( P <0.005).It was found that both p53 and p21 genes' overexpression was closely related to the degree of malignancy and the distance between the edge of the remnant stomach and the edge of the tumor.The variation of the expression of p53,p21 genes in the upper gastric mucosa adjacent to the gastric carcinoma dropped gradually from the part adjacent to the tumor to the edge of the remnant stomach;it dropped from the lesser curvature to the greater curvature.The distribution of p53,p21 genes was almost a normal distribution,with the zenith of the distribution about 4～5cm above the edge of the tumor in the lesser curvature. Conclusion The positive expression of p53,p21 genes on the edge of the remnant stomach is a negative factor in judging the patient after surgery,especially when both p53 and p21 express positive.The distance should be long enough(≥5cm) from the edge of the tumor to the gastrotomical edge in the lesser curvature.The negative criterion in judging the edge of the remnant stomach should be both p53 and p21 express negative in addition that no tumor cells were observed on the edge stained with HE.