唾液酸化Lewis X在大肠癌中的表达及其意义

EXPRESSION AND SIGNIFICANCE OF SIALYL-LeX IN COLORECTAL CARCINOMA

目的研究大肠癌组织中细胞粘附分子唾液酸化 Ｌｅｗｉｓ Ｘ（ｓｉａｌｙｌ－ＬｅＸ）表达状况与肿瘤发生、分化、转移及预后的关系。方法应用免疫组化微波－ＬＳＡＢ法和计算机图像分析技术，对９０例大肠癌和３０例远离癌组织的正常大肠粘膜进行ｓｉａｌｙｌ－ＬｅＸ表达和反应强度定量检测，并对其中５３例患者进行随访。结果ｓｉａｌｙｌ－ＬｅＸ阳性物质在远离癌组织的正常大肠粘膜中阳性率为 １６．７％（５／３０），仅限于一些深部腺腔缘游离面；而大肠癌组织中ｓｉａｌｙｌ－ＬｅＸ阳性表达率高达 ９２．２％（８３／９０），主要分布于腺管顶面细胞浆，腺腔内和癌细胞胞浆内以及粘液湖内。图像分析，ｓｉａｌｙｌ－ＬｅＸ阳性细胞平均积分光密度值在低分化腺癌中显著高于高、中分化腺癌和粘液腺癌（Ｐ＜０．０１）；有淋巴结转移者显著高于无淋巴结转移者（Ｐ＜０．０１）； ５年内死亡患者显著高于生存患者（Ｐ＜０．０１）。结论 ｓｉａｌｙｌ－ＬｅＸ表达阳性率和反应强度对反映大肠癌组织发生、判断恶性程度、预测转移和评估患者预后具有重要意义。

Objective To investigate the level of cell adhesion molecule sialyl-LeX expression in colorectal carcinoma and its relation with carcinogenesis, differentiation, metastasis and prognosis. Methods Sialyl-LeX expression and its optical density in colorectal carcinoma (n=90) and remote normal mucosa (n=30) were quantitatively studied with microwave-LSAB immunohistochemical method combined with image analysis technique. Fifty-three patients were followed up. Results The weaker staining in remote normal colorectal mucosa was observed in very limited parts of some deep crypts. Positive rate of sialyl-LeX expression was only 16. 7 % (5/30 ). The positive expression of sialyl-LeX was observed in 83 of 90 patients with colorectal carcinoma(92. 2 % ). The apical cytoplasma of cancer tubules, the luminal contents, and the cytoplasma of the cancer cells were strongly stained. The mean integral optical density of sialyl-LeX positive cell in poorly differentiated adenocarcinoma was significantly higher than that in highly differentiated and mucinous ones t (P＜ 0. 01 ). It was markedly higher in patients with positive lymphatic nodes than that in negative ones (P＜0.01). With followed-up for longer than 5 years, it was much lower in the alive cases than that in the dead (P＜0.01). Conclusion These findings indicate that changes of sialyl-LeX expression and its optical density is related to carcinogenesis, differentiation, invasion and metastasis of colorectal carcinoma. It may be a good predicter for the prognosis of patients with colorectal carcinoma.