P504S对活检胃低级别上皮内瘤变行内镜黏膜下剥离术后病理升级的预测价值

Predictive value of P504S for pathological upgrading of gastric low-grade intraepithelial neoplasia after endoscopic submucosal dissection

目的:分析P504S对胃低级别上皮内瘤变行内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)后病理升级的预测作用。方法:回顾性分析2015年1月—2019年3月华东医院消化内镜室活检为低级别上皮内瘤变(low-grade intraepithelial neoplasia,LGIN)行ESD的117例(119个病灶)患者资料,收集活检和ESD标本。根据病理升级情况分为LGIN组(术后病理未升级)和升级组(术后病理升级)。比较LGIN组活检病理、LGIN组术后病理、升级组活检病理、升级组术后病理的P504S阳性率。检测LGIN组和升级组活检病理和术后病理P504S表达的一致性。绘制活检病理P504S染色预测病理升级的受试者工作特征(receiver operator characteristic,ROC)曲线,并计算免疫组化染色评分的cutoff值。结果:P504S阳性率LGIN组活检病理为46.8%(36/77),低于升级组活检病理73.2%(30/41),差异有统计学意义(P=0.006)。P504S阳性率LGIN组术后病理为51.9%(40/77),低于升级组术后病理82.9%(34/41),差异有统计学意义(P=0.001)。在LGIN组内,P504S阳性率活检病理低于术后病理[46.8%(36/77)比51.9%(40/77),P=0.289]。LGIN组活检和术后病理表达存在一致性,一致性好(K=0.793,P<0.001)。在升级组内,P504S阳性率活检病理低于术后病理[73.2%(30/41)比82.9%(34/41),P=0.219]。升级组活检和术后病理表达存在一致性,一致性一般(K=0.579,P<0.001)。根据活检病理P504S染色预测病理升级的ROC曲线,免疫组化染色评分cutoff值为100,阳性结果发生病理升级的灵敏度为0.659,特异度为0.740。结论:ESD术后病理行P504S染色,有助胃黏膜瘤变程度的鉴别诊断。染色评分cutoff值为100时,活检组织P504S染色对病理升级有一定预测作用。

Objective To analyze the predictive value of P504S for pathological upgrading of gastric low-grade intraepithelial neoplasia(LGIN)after endoscopic submucosal dissection(ESD).Methods Data of 117 patients(119 lesions)who underwent ESD for LGIN at Huadong Hospital from January 2015 to March 2019 were analyzed retrospectively.Biopsy and ESD specimens were collected.According to pathology,specimens were divided into the LGIN group(postoperative pathology of non-upgrade)and the upgrade group(postoperative pathology of upgrade).The positive rates of P504S were compared between biopsy and postoperative specimens of the LGIN group,and between biopsy and postoperative specimens of the upgrade group.The consistency of the expression of P504S was examined between the biopsy specimens and the postoperative specimens in the LGIN group and the upgrade group.Receiver operator characteristic(ROC)curve of the prediction of pathological upgrading was drawn by the results of P504S in biopsy,and the cutoff value of immunohistochemical staining score was calculated.Results The positive rate of P504S in the biopsy specimens of the LGIN group(46.8%,36/77)was lower than that in the biopsy specimens of the upgrade group(73.2%,30/41)with significant difference(P=0.006).The positive rate of P504S in the postoperative specimens of the LGIN group(51.9%,40/77)was lower than that in the postoperative specimens of the upgrade group(82.9%,34/41)with significant difference(P=0.001).In the LGIN group,the positive rate of P504S in biopsy specimens(46.8%,36/77)was lower than that in postoperative specimens(51.9%,40/77)without significant difference(P=0.289).The expression of P504S was consistent between biopsy specimens and postoperative specimens with good consistency(K=0.793,P<0.001).In the upgrade group,the positive rate of P504S in biopsy specimens(73.2%,30/41)was lower than that in the postoperative specimens(82.9%,34/41)without significant difference(P=0.219).The expression of P504S was consistent between biopsy and postoperative specimens,and the consistency was general(K=0.579,P<0.001).ROC curve was drawn for the prediction of pathological upgrading by the results of P504S in biopsy,and the cutoff value of immunohistochemical staining score was 100.The sensitivity and specificity of pathological upgrading for positive result were 0.659 and 0.740,respectively.Conclusion P504S staining of the postoperative specimens facilitates identification of the degree of gastric mucosal neoplasia.When the cutoff value of staining score is 100,the staining of P504S in biopsy tissue plays a role in predicting the pathological upgrading.