胃癌原发灶与腹膜种植转移灶癌胚抗原的表达研究

Expression of carcinoembryonic antigen in primary tumors and peritoneal metastases of gastric carcinoma

目的 探讨胃癌癌组织癌胚抗原（CEA）表达和血清CEA水平与腹膜种植转移的关系.方法 回顾分析38例有腹膜种植转移的胃癌患者（A组）和60例无腹膜种植转移的胃癌患者（B组）,分析两组患者术前首次血清CEA的水平,通过免疫组织化学方法检测A组阴性切缘、原发灶和腹膜种植转移灶以及B组原发灶中CEA的表达,检测结果进行相应的统计学分析.结果 A组和B组中术前首次血清CEA阳性率分别为73.68％和41.67％,两组比较差异有统计学意义（x2=9.604,P=0.002）;两组患者术前首次CEA血清水平分别为（74.00±6.00） ng/mL,（46.06±9.03） ng/mL,两组CEA血清水平的差异比较同样有统计学意义（=4.715,P＜0.01）.在A组中,胃癌原发灶CEA阳性率为68.42％,明显高于阴性切缘正常胃黏膜中的2.63％（x2=29.587,P=0.000）;CEA在胃癌原发灶与阴性切缘中阳性强度表达差异有统计学意义（Z=-5.348,P=0.000）.在腹膜种植转移灶中的阳性率为92.11％,明显高于原发灶的68.42％（x2=6.728,P=0.009）;同时,CEA在腹膜种植转移灶与原发灶中阳性表达的强度差异也有统计学意义（Z=-2.397,P=0.017）.A组中原发灶和B组中原发灶CEA的表达阳性率分别为68.42％和46.67％,两组比较差异有统计学意义（r=4.450,P=0.035）;两组CEA的表达强度差异也有统计学意义（Z=-2.227,P=0.026）.结论 原发肿瘤CEA过度表达可能与胃癌腹膜种植转移有关,CEA在胃癌不同组织中表达的差异性可能预示胃癌腹膜种植转移的风险.

Objective To further explore the relationship of CEA in gastric cancer tissue expression and serum levels,and seek after the prediction effect of serum CEA in the peritoneal metastasis.Methods Retrospective analysis of 38 gastric cancer patients with peritoneal metastasis （group A） and 60 gastric cancer patients without peritoneal mnetastasis （group B）,and analyze the first time in two groups of patients with preoperative serum CEA levels.The expression levels of CEA was examined by Immunohistochemistry method in primary tumors、negative margin and peritoneal metastases foci from group A and in primary tumors from group A,and the detection result of the statistical was analyzed.Results The expression of the first preoperative CEA serum levels in group A and group B was 73.68％ and 41.67％ respectively （x2 =9.604,P =0.002）,and the two groups of patients with the first preoperative CEA serum levels was （74.00 ＋ 6.00） ng/mL,（46.06 ＋ 9.03） ng/mL,The two groups was statistically significant （t =4.715,P ＜0.01）.In group A,the expression of CEA of primary tumors was higher than that of negative margins （x2 =29.587,P =0.000）;the difference expression of CEA positive degree in gastric cancer primary tumors and negative margins was statistically significant（Z =-5.348,P =0.000）.In peritoneal metastases foci the expression of CEA was 92.11％,that was 64.82％ in primary tumor（x2 =6.728,P =0.009）;the difference expression of CEA positive degree in peritoneal metastases foci and primary tumors was statistically significant （Z =-5.397,P =0.017）.In primary tumors,the expression of CEA in group A and group B was 68.42％ and 42.67％ respectively （x2 =4.450,P =0.035）,the two groups of patients with the difference expression of CEA positive degree was statistically significant,the two groups was statistically significant（Z =-2.227,P =0.026）.Conclusion Over expression of CEA might have a critical role in peritoneal metastases of gastric carcinoma.The differences of the expression of CEA in gastric cancer in different tissues may indicate the risk of gastric cancer peritoneal metastasis.