胃癌淋巴结转移囊外生长与预后和SOX9表达的相关性

Correlation of Extracapsular Involvement of Lymph Node Metastasis With Prognosis and SOX9 Expression in Gastric Cancer Patients

背景:恶性肿瘤淋巴结转移的囊外生长模式与患者预后密切相关。目的:探讨胃癌患者淋巴结转移囊外生长对预后的影响,及其与转录因子SOX9表达的相关性。方法:回顾性连续收集2010年1月—2014年12月西安市第一医院200例淋巴结转移阳性、TNMⅠ~Ⅲ期胃癌患者,根据淋巴结转移生长模式分为囊外生长组和囊内生长组,比较两组临床病理特征、总体生存期和SOX9表达情况。采用Cox比例风险模型对预后相关因素行单因素和多因素分析。结果:囊外生长组T分期T3、T4期比例、N分期N2、N3期比例、TNMⅡ~Ⅲ期比例以及SOX高表达率(94.5%对58.3%)均显著高于囊内生长组(P<0.05)。Kaplan-Meier生存曲线分析显示囊外生长组总体生存期显著短于囊内生长组(P<0.05)。多因素分析表明,TNMⅡ~Ⅲ期(HR=3.224,95%CI:2.769~5.283,P<0.001)、淋巴结转移囊外生长(HR=2.388,95%CI:1.802~3.209,P<0.001)和转移淋巴结SOX9高表达(HR=1.321,95%CI:1.201~1.684,P=0.001)是影响胃癌患者总体生存期的独立危险因素。结论:胃癌患者淋巴结转移囊外生长与SOX9高表达相关,是预测预后不良的独立危险因素,以及肿瘤侵袭、转移的组织形态学标志。

Background:The extracapsular involvement(ECI)of lymph node metastasis has been considered as an important prognostic factor in patients with malignancies.Aims:To investigate the influence of ECI of lymph node metastasis on prognosis of patients with gastric cancer and its correlation with expression of transcriptional factor SOX9.Methods:A retrospective study was conducted in 200 consecutive gastric cancer patients with lymph node metastasis(TNM stageⅠ-Ⅲ)from Jan.2010 to Dec.2014 at Xi’an No.1 Hospital.Patients were allocated into two groups according to the presence or absence of ECI,and their differences in clinicopathological characteristics,overall survival and SOX9 expression were compared.Univariate and multivariate analyses were performed by Cox proportional hazard model to identify the risk factors for poor prognosis.Results:ECI was associated with advanced T stage(T3,T4),N stage(N2,N3)and TNM stage(stageⅡ-Ⅲ),respectively(P<0.05).Furthermore,high expression of SOX9 was more frequently seen in metastatic lymph node with ECI than that without(94.5%vs.58.3%,P<0.05).Kaplan-Meier survival analysis confirmed that patients in ECI group were associated with significantly shorter overall survival time(P<0.05).In multivariate analysis,TNM stageⅡ-Ⅲ(HR=3.224,95%CI:2.769-5.283,P<0.001),ECI of lymph node metastasis(HR=2.388,95%CI:1.802-3.209,P<0.001)and high expression of SOX9 in metastatic lymph node(HR=1.321,95%CI:1.201-1.684,P=0.001)were found to be the independent risk factors of poor overall survival in patients with gastric cancer.Conclusions:ECI of lymph node metastasis is associated with high expression of SOX9 in gastric cancer patients and can be used as an independent risk factor for poor prognosis.Also,ECI is a histomorphological indicator for invasive and metastatic phenotype of gastric cancer.