分化型早期胃癌中原始表型及其临床病理学意义研究

The Existence and Clinicopathological Significance of Primitive Phenotypes in Early Gastric Cancer

目的:探讨分化型早期胃癌(EGC)中有无原始表型的存在,及其临床病理学意义。方法:选取2018年3月至2022年2月于我院手术切除的82例分化型EGC病理标本,采用免疫组织化学、过碘酸雪夫氏(PAS)和淀粉酶消化法(D-PAS)染色。观察原始标志物在原始表型分化型EGC中的表达、分化型EGC原始表型与临床病理特征关系、分化型EGC临床病理特征与淋巴结转移(LNM)关系,分析分化型EGC是否满足内镜切除指征和有无LNM存在。结果:所有分化型EGC病例中10.98%具有原始表型。具有原始表型的分化型EGC患者比无原始表型的侵袭更深,溃疡和淋巴血管浸润率更高。此外,具有原始表型的分化型EGC患者出现LNM频率为66.67%,高于无原始表型的24.66%(P<0.05)。多因素分析显示,原始表型是LNM的独立危险因素(P=0.002)。2例具有原始表型的分化型EGC病例发生LNM,都符合内镜切除分化型EGC的扩展适应证。结论:少数分化型EGC具有原始表型,与LNM密切相关,是LNM的独立危险因素。鉴于其高度侵袭性行为,具有原始表型的分化型EGC应在内镜切除前以更严格标准评估,或考虑在内镜切除后进行额外外科手术。

Objective:To investigate the existence of primitive phenotypes in differentiated early gastric cancer(EGC)and its clinicopathological significance.Methods:82 differentiated EGC pathological specimen were selected in our hospital from March 2018 to February 2022,and the samples were stained by immunohistochemistry,periodic acid schiff(PAS)and D-PAS.The expression of primitive markers in primitive phenotypic differentiated EGC,the relationship between primitive phenotype of differentiated EGC and clinicopathological features,and the relationship between clinicopathological features of differentiated EGC and lymph node metastasis(LNM)were observed to analyze whether differentiated EGC met the indications of endoscopic resection and whether LNM existed.Results:10.98%of all differentiated EGC cases had primitive phenotypes.Patients with the primitive phenotype had deeper invasions and higher rates of ulcers and lymphatic infiltration than those without the primitive phenotype.In addition,the incidence of LNM in patients with primitive phenotype(66.67%)were higher than that of patients without primitive phenotype(24.66%)(P<0.05).Multivariate analysis showed that the presence of a primitive phenotype was an independent risk factor for LNM(P=0.002).LNM occurred in two cases with primitive phenotypes,and all met the extended indications for endoscopic resection of differentiated EGC.Conclusion:A few differentiated EGCs have primitive phenotypes,which are closely related to LNM and are independent risk factors for LNM.Given its highly invasive behavior,differentiated EGC with primitive phenotype should be evaluated according to stricter criteria prior to endoscopic resection,or additional surgical procedures should be considered after endoscopic resection.