TCF-4、MMP-7及APC在大肠侧向发育型肿瘤的表达及临床意义

Expression and clinical significance of TCF-4,MMP-7 and APC in laterally spreading tumor

目的研究TCF-4、MMP-7及APC蛋白在大肠侧向发育型肿瘤(LST)的表达及临床意义,探讨Wnt/β-catenin信号通路与LST发生及癌变的关联。方法收集中南大学湘雅二医院2010年1月至2015年7月接受内镜下治疗的LST 55例、隆起型腺瘤(PA)20例及炎性息肉(IP)10例,统计分析临床病理资料,应用免疫组化染色技术检测各组中TCF-4、MMP-7及APC蛋白表达情况。结果(1)临床病理资料:LST组与PA组在性别、年龄上无统计学差异(P>0.05);LST组直径明显大于PA组;LST组主要分布于直肠,PA组多位于远端结肠;LST以绒毛-管状腺瘤为主,PA为管状腺瘤为主(P<0.05);LST与PA均以低级别瘤变为主(P>0.05),而LST癌变率20.0%,PA无癌变。(2)免疫组化染色:TCF-4、MMP-7在LST组表达强于PA组及IP组(P<0.05);APC在LST组表达弱于PA组及IP组(P<0.05)。在LST组中,TCF-4与MMP-7表达呈正相关,APC与TCF-4、MMP-7呈负相关(P<0.05)。结论(1)与PA相比,LST病变直径大、好发于直肠;病理分型以绒毛-管状腺瘤为主,常合并低级别瘤变;当LST发展为高级别上皮内瘤变后,容易癌变。(2)LST中存在TCF-4、MMP-7的高表达及APC的低表达,LST癌变可能与Wnt/β-catenin信号通路激活有关。

Objective To investigate the expression and clinical significance of TCF-4, MMP-7 and APC in laterally spreading tumor （LST） and to discuss the relationship between the Wnt/β-catenin signaling pathway and the development and carcinogenesis in LST. Methods A total of 55 patients with LST, 20 protruded-type eoloreetal adenoma （PA）, and 10 inflammatory polyp were included who underwent endoscopic operation from January 2010 to July 2015 in the endoscopic center of the Second Xiangya Hospital, Central South University. The clinicopathologic data were analyzed and the expression of TCF-4,MMP-7 and APC protein were detected by immunohistochemical staining method. Results （1） Clinicopathologic features ：There was no significant difference between LST and PA in gender, age and grades of intraepithelial neoplasia （ P 〉 0.05 ）. The mean size of LST was significantly larger than that of PA and IP （ P 〈 0.05 ）. LST mainly located in rectum, whereas PA in distal colon. There was significant difference in histological type between LST, mainly tubulovillous adenomas and PA, mainly tubular adenomas. The pathological grade of them was mainly low grade intraepithelial neoplasia （ P 〉 0.05 ）. The eanceration rate of LST was 20.0% , and there was no caneeration in PA. （ 2 ） Immunohistochemistry ： The expression of TCF-4 and MMP-7 was higher in LST group than in PA group and IP group（P 〈0. 05）. The expression of APC was lower in LST group than in PA group and IP group （ P 〈 0.05 ）. There exists positive relationship between the expression of TCF-4 and MMP-4 in LST group, and negative relationship between the expression of APC and TCF-4, MMP-7 （P 〈 0.05 ）. Conclusions （ 1 ） In comparison with PA, I.ST has larger diameter, and located more frequently in rectum. The pathological type is mainly tubutovillous adenomas, often with low grade intraepithelial neoplasia. When LST developed to high grade intraepithelial neoplasia, it will be easier become malignant. （2）There was high expression of TCF-4 and MMP-7 ,as well as weak expression of APC in I.ST. Carcinogenesis of LST may be related with the activation of Wnt/β-catenin signaling pathway.