Barrett’s食管与腺癌的关系研究

Relevance of adenocarcinoma of the distal esophagus, esophagogastric junction and Barrett's esophagus

目的 了解食管末端腺癌及胃 食管交界处腺癌发生与Barrett’s食管 (BE)的相关性及特点 ,并明确P2 7kip1及增殖细胞核抗原 (PCNA)在腺癌组织、癌周不典型增生、癌周肠化生处的表达及意义。方法 收集1996年 1月～ 2 0 0 0年 6月间西安各大医院食管末端腺癌切除标本 15例 ,胃 食管交界处腺癌标本 30例 ,4 5例均行AB(pH 2 .5 )特殊染色进行PCNA及P2 7kip1免疫组织化学检测 ,分析不同组织中的PCNA指数 ,P2 7kip1在肿瘤组织、肿瘤周围重度不典型增生及肠化组织中的表达。P2 7kip1的表达与肿瘤的分化类型、浸润深度及有无淋巴转移等之间的相关性 ,P2 7kip1表达与PCNA表达间的相关性。结果 ① 6 0 .0 %的食管腺癌及 5 3.3%的胃、食管交界处腺癌与BE相关。②PCNA表达在肠化生、重度不典型增生、腺癌组织中呈逐渐增高趋势 ,差异有显著性。③P2 7kip1在腺癌组织中的阳性率为 2 6 .7% ,在不典型增生组织中的阳性率为 5 3.3% ,在肠化组织中阳性率为 88.9% ,正常对照阳性率为 90 %。结论 6 0 %食管末端腺癌与BE相关 ,P2 7kip1胞核表达与肿瘤分化类型、浸润深度及有无淋巴转移等呈负相关 ,P2

Objective To investigate the prevalence of Barrett's esophagus in patients with adenocarcinomas located at the distal esophagus and the gastroesophgeal junction, and to evaluate the expression of P 27 kip1 and PCNA in Barrett's intestinal metaplasia, dysplasia and adenocarcinoma of esophagus and esophagogastric junction. Methods 45 Patients who had undergone esophagogastrectomy for adenocarcinoma of the distal esophagus, cardia or proximal stomach between January 1996 and June 2000 constituted the study population. Eosin alcian blue (pH 2.5) stain was used for histologic demonstration of intestinal metaplasia of Barrett's esophagus. Immunohistochemistry was used to evaluate the expression of P 27 kip1 and PCNA. Finally the correlations between the expression of P 27 kip1 and tumor differenitiation, depth of invasion, lymph node metastases and the expression of PCNA were analyzed. Results ①Intestinal metaplasia was identified in the histological sections from the resected specimens in 53.3% of esophagogastric junction adenocarci nomas and in 60.0% of esophageal adenocarcinomas. ②The PCNA index of malignant tissue was signifcantly greater than either that of intestinal metaplasia or dysplastic tissue. ③ P 27 kip1 was inactivated in the majority of malignant specimens. Loss of the cell cycle inhibitor P 27 kip1 was associated with the parameters of aggressive behavior in either esophagogastric junction adenocarcinomas or esophageal adenocarcinomas. Conclusions Obvious association exists between 60% of esophageal adenocarcinoma and BE while the increased nuclear expression of P 27 kip1 is negatively correlated with deep invasive change and PCNA index.