早期胃癌组织MCM4表达与内镜黏膜下剥离术后疾病复发的关系

Relationship Between the Expression of MCM4 in Early Gastric Cancer and Recurrence After Endoscopic Submucosal Dissection

目的探讨微小染色体维持蛋白4(MCM4)在早期胃癌组织中的表达及其与内镜黏膜下剥离术后疾病复发的关系。方法选取2017年2月至2020年1月在医院接受内镜黏膜下剥离术的273例早期胃癌患者作为观察组,另同期选取在医院接受胃镜下胃黏膜活检正常的200例受试者作为对照组。采用免疫组化法检测MCM4在胃癌组织和正常胃黏膜组织中的表达,比较不同病理特征早期胃癌患者胃黏膜癌组织MCM4表达。根据早期胃癌患者术后3 a内复发情况分为复发组和未复发组,绘制Kaplan-Meier曲线分析早期胃癌组织MCM4不同表达患者术后复发情况。采用Cox回归模型分析术后复发的影响因素。结果观察组胃黏膜癌组织MCM4高表达率高于对照组胃黏膜正常组织(P<0.05);黏膜下层浸润、低/未分化早期胃癌患者胃癌组织MCM4高表达占比分别高于黏膜内层浸润、高/中分化患者(P<0.05);早期胃癌内镜黏膜下剥离术后3 a复发率为11.36%(31/273),Kaplan-Meier曲线显示,胃癌组织MCM4高表达患者术后3 a复发率高于低表达患者(P<0.05);Cox回归分析结果显示,病灶最大直径>3 cm、黏膜下层浸润、低/未分化及胃癌组织MCM4高表达均是早期胃癌患者内镜黏膜下剥离术后复发的危险因素(P<0.05)。结论早期胃癌组织MCM4呈高表达,与浸润程度、分化程度有关,是内镜黏膜下剥离术后复发的危险因素。

Objective To investigate the expression of microchromosome maintenance protein 4(MCM4)in early gastric cancer and its relationship with recurrence after endoscopic submucosal dissection.Methods A total of 273 patients with early gastric cancer who underwent endoscopic submucosal dissection in hospital from February 2017 to January 2020 were selected as the observation group,and 200 patients with normal gastric mucosa biopsy under endoscopy in hospital were selected as the control group at the same time.The expression of MCM4 in gastric cancer tissue and normal gastric mucosa tissue was detected by immunohistochemistry,and the expression of MCM4 in gastric mucosa cancer tissue of patients with different pathological characteristics was also compared.The patients with early gastric cancer were divided into recurrent group and non-recurrent group according to the recurrence within 3 years after operation.Kaplan-Meier curve was drawn to analyze the recurrence of patients with different expression of MCM4 in early gastric cancer tissue,and the influencing factors of postoperative recurrence was analyzed by Cox regression model.Results The high expression rate of MCM4 in gastric mucosa cancer tissue of the observation group was higher than that in normal gastric mucosa tissue of the control group(P<0.05).The proportion of high expression of MCM4 in gastric cancer tissue of patients with submucosal invasion and low/undifferentiated early gastric cancer was higher than that of patients with submucosal invasion and high/medium differentiation(P<0.05).The 3-year recurrence rate of early gastric cancer after endoscopic submucosal dissection was 11.36%(31/273).Kaplan-Meier curve showed that the 3-year recurrence rate of patients with high expression of MCM4 in gastric cancer tissue was higher than that of patients with low expression of MCM4(P<0.05).Cox regression analysis showed that the maximum diameter of the lesion>3 cm,submucosal infiltration,low/undifferentiated and high expression of MCM4 in gastric cancer tissue were all risk factors for recurrence in patients with early gastric cancer after endoscopic submucosal dissection(P<0.05).Conclusion MCM4 is highly expressed in early gastric cancer tissue,and it is related to the degree of invasion and differentiation.The high expression of MCM4 is a risk factor for recurrence after endoscopic submucosal dissection.