食管癌伴E-NED的临床病理特点及诊断标志物探讨

The investigation of clinico- pathological characteristics and diagnostic biomarkers in patients with esophageal carcinoma accompanied by neuroendocrine cell differentiation

目的通过对食管癌伴神经内分泌分化(E-NED)的临床病理特点及诊断的标志物进行探讨,进一步加深对其的认识。方法回顾性分析2007年1月至2014年12月经病理确诊的食管癌389例患者的临床资料,其中ENED38例,食管癌不伴NED(E-NNED)351例。分析389例食管癌患者的性别、发病年龄、病变位置、浸润的深度及长度、TNM分期、淋巴结转移情况等资料,对比E-NED与E-NNED患者的临床病理学特征。通过免疫组织化学方法检测38例E-NED及随机选取的40例E-NNED患者的肿瘤组织中嗜铬蛋白A(Cg A)、神经细胞黏附分子(CD56)、突触素(Syn)、神经元特异度烯醇化酶(NSE)、促泌素(SCGN)、蛋白基因产物9.5(PCP9.5)、甲状腺转录因子1(TTF-1)的表达。结果 E-NNED与E-NED患者的性别、年龄、病变长度等病理因素之间差异无统计学意义(P>0.05)。ENED患者的Cg A、CD56、Syn、NSE、SCGN、PCP9.5表达均较E-NNED组患者的高,差异有统计学意义(P<0.05),但TTF-1两组间无显著差异(P>0.05)。Syn分别与CD56、SCGN或PGP9.5组成的3种组合诊断E-NED的阳性预测值、敏感度及准确率均高于Syn与Cg A的组合,差异有统计学意义(P<0.05)。结论 E-NED与E-NNED可能为不同病理类型的食管癌,SCGN与PGP9.5可作为E-NED的诊断标志物,且Syn与PGP9.5、CD56或SCGN联合检测可提高E-NED的诊断敏感度及准确率。

Objective To investigate the clinico - pathological characteristics and diagnostic biomarkers in esophageal carcinoma accom-panied by neuroendocrine cell differentiation（E - NED）. Methods Retrospectively analyze the clinical data of 389 cases of esophageal cancer patients in our hospital between January 2007 and December 2014 menstrual pathological diagnosis,including 38 cases with neuroendocrine cell differentiation（E - NED）,351 cases without neuroendocrine differentiation. Analyze esophageal cancer patients′ gender,age,lesion location, length and depth of invasion,TNM stage,lymph node metastasis,etc. ,and compare clinicopathological features between E - NED and E - NNED patients. Detect the expression of the chromogranin A（CgA）and neural cell adhesion molecule（CD56）,synaptic element（Syn）,neuron spe-cific enolization enzyme（NSE）,secretagogin（SCGN）,protein gene product 9. 5（PCP9. 5）,thyroid transcription factor 1（TTF^-1）using im-munohistochemical methods to chromaffin tumor tissues of 38 E - NED patients and randomly selected 40 patients with E - NNED. Results There was no significant difference between the E - NNED patients and E - NED patients with pathological factors such as gender,age,length of lesion（ P 〉 0. 05）. The expression of the CgA,CD56,Syn,NSE,SCGN,PCP9. 5 in E - NED patients was higher than E - NNED group pa-tients,the difference was statistically significant. However,the TTF^-1 had no obvious difference between the two groups. The positive predictive value,sensitivity and accuracy of Syn respectively with one of the kinds of combinations of PGP9. 5,CD56 or SCGN were higher than the Syn and the combination of CgA,and the difference was statistically significant. Conclusion E - NED and E - NNED may be different pathological type of esophageal cancer,both the SCGN and PGP9. 5 could be used as diagnostic markers for E - NED,and the combined detection of Syn and PGP9. 5,CD56,or SCGN E - NED joint detection can improve diagnostic sensitivity and accuracy.