食管胃结合部腺癌淋巴结转移特点及临床意义和分子机制的研究

发布时间：2018-06-07 22:59

本文选题：食管胃结合部腺癌 + 临床病理分析　；参考：《首都医科大学》2017年硕士论文

【摘要】：目的:探讨Siewert II型和III型食管胃结合部腺癌淋巴结转移特点及其临床意义。方法:对2014年8月至2016年8月期间进行食管胃结合部腺癌根治切除术加淋巴结清扫术的67例患者,将其手术切除标本进行取材,由病理学家和临床医生共同收集淋巴结,进行细致的分组,逐枚进行病理组织学和免疫组织化学检查,判断淋巴结是否转移并计算淋巴结转移率和淋巴结转移度。分析淋巴结转移率和淋巴结转移度与肿瘤大小、TNM分期(Tumor Node Metastasis,TNM)、Borrmann分型、肿瘤分型等方面的关系。结果:67例食管胃结合部腺癌患者中,Siewert II型有49例,淋巴结转移阳性31例(63.3%),共收获961枚淋巴结,平均每例19.6枚;Siewert III型有18例,淋巴结转移阳性11例(61.1%),Siewert III型共收获512枚淋巴结,平均每例28.4枚。肿瘤直径与淋巴结转移率的关系差异无统计学意义(P0.05),但肿瘤直径与淋巴结转移度的关系差异有统计学意义(P0.001)。TNM分期中,淋巴结转移率随着肿瘤分期的增加而增加,IIIB和IIIC期患者淋巴结转移率均为100%,其转移度在31.46%~39.94%之间,较I、II期者高(P0.001)。Borrmann分型中,III型病例的淋巴结转移率(75.00%)较其他型患者高(P0.05)。在淋巴结转移率上,Siewert II型淋巴结转移率由高到低依次为第3、1、2、7=11、4=8,9=5=110组,以3组转移率为最高(46.94%);Siewert III型淋巴结转移率由高到低依次为第3、1=2、7=11、9=6、4=8=5组,其中最高转移率为第3组(55.56%);食管胃结合部腺癌各分型与淋巴结转移率的关系差异无统计学意义(P0.05)。在淋巴结转移度上,Siewert II型中,淋巴结转移度由高到低依次是,第2、1、110、3、11、5、7、4、8、9组,其中转移度最高的是2组(48.72%)。Siewert III型中,淋巴结转移度由高到低依次是,第2、3、11、7、6、5、1、9、8、4组,其中转移度最高的是2组(80.95%);在淋巴结转移度中Siewert II型和III型在第1组(p=0.001),2组(p=0.015),6组(p=0.03)中,存在统计学差异。结论:Siewert II型和III型食管胃结合部腺癌临床病理特征显著不同;不同分型的食管胃结合部腺癌的淋巴结转移率无统计学差异,这可能与病例数偏少有关,在本组研究中,与Siewert III型肿瘤相比,II型肿瘤更易出现食管旁的淋巴结(第110组)转移。在淋巴结转移度方面,Siewert II型肿瘤更易出现贲门右淋巴结(第1组)(P0.05),而Siewert III型肿瘤更易出现贲门左淋巴结(第2组)(P0.05)淋巴结转移,二者存在明显的统计学差异。因此,Siewert II型肿瘤有必要清扫110组、1组,Siewert III型肿瘤有必要清扫第2组淋巴结。目的:探究Siewert II食管胃结合部腺癌组织中PDZK1和PDGFR-β的表达以及相互之间的作用,对比PDZK1和PDGFR-β在Siewert II型食管胃结合部腺癌与远端胃癌的表达差异。方法:从患者组织蜡块中采集标本,制作成石蜡切片,进行免疫组织化学染色。采用半定量评分系统评定免疫组织化学染色结果并做统计分析。结果:PDZK1在食管胃结合部腺癌组织中阳性表达率为30%(12/40),在食管胃结合部正常组织中阳性表达率为95%(38/40),差异有统计学意义(χ2=36.053,P0.001)。PDGFR-β在食管胃结合部腺癌组织中阳性表达率为80%(32/40),食管胃结合部正常组织中阳性表达率为28%(11/40),差异有统计学意义(χ2=22.175,P0.001)。PDZK1和PDGFR-β在食管胃结合部正常组织无明显相关性(r=0.026,P=0.874),PDZK1和PDGFR-β在食管胃结合部腺癌组织无明显相关性(r=0.111,P=0.497)。对比远端胃癌,结果发现PDZK1在胃食管结合部正常组织中表达要高于远端胃正常组织(Ζ=-1.997,P=0.046),同样PDGFR-β在胃食管结合部腺癌组织中表达要高于远端胃癌组织(Ζ=-3.811,P=0.000),差异具有统计学意义。结论:PDGFR-β在Siewert II食管胃结合部腺癌组织中呈现高表达,PDZK1在Siewert II食管胃结合部正常组织中呈现高表达。PDZK1与PDGFR-β在Siewert II食管胃结合部腺癌组织和正常组织中的表达均未表现出相关性。Siewert II型食管胃结合部腺癌中PDZK1与PDGFR-β的表达要高于远端胃癌,结合其临床特点,食管胃结合部腺癌可能是不同于远端胃癌的一类特殊肿瘤,而且PDZK1有可能在AEG的分子分型和靶向治疗方面提供一定的参考价值。
[Abstract]:Objective: To investigate the characteristics and clinical significance of lymph node metastasis of Siewert II and III type esophagogastric junction adenocarcinoma. Methods: 67 patients with adenocarcinoma resection of the esophagogastric junction and lymph node dissection were performed from August 2014 to August 2016, and the specimens were removed and collected by the pathologists and clinicians. Lymph node metastasis rate and lymph node metastasis rate and tumor size, TNM staging (Tumor Node Metastasis, TNM), Borrmann classification, tumor typing, etc. were analyzed for lymph node metastasis and lymph node metastasis. Results: among the 67 cases of adenocarcinoma of the esophagogastric junction, there were 49 cases of Siewert II and 31 cases of lymph node metastasis (63.3%), and 961 lymph nodes were harvested, with an average of 19.6 nodes, 18 cases of Siewert III, 11 cases of lymph node metastasis (61.1%), and 512 lymph nodes of Siewert III, the average of 28.4. Tumor diameter and lymph nodes There was no statistical significance (P0.05), but the difference in the relationship between tumor diameter and lymph node metastasis was statistically significant (P0.001) in.TNM staging, the lymph node metastasis rate increased with the increase of tumor staging. The lymph node metastasis rate in IIIB and IIIC patients was 100%, and the metastatic degree was between 31.46%~39.94%, higher than that of I and II stage. (P0.001).Borrmann typing, the lymph node metastasis rate of III type cases (75%) was higher than that of other type patients (P0.05). In the lymph node metastasis rate, the Siewert II lymph node metastasis rate from high to low was in group 3,1,2,7=11,4=8,9=5=110, with the highest transfer rate in the 3 group (46.94%); Siewert III type lymph node metastasis rate was in the order of 3,1=2 in the order of high to low. In group 7=11,9=6,4=8=5, the highest metastasis rate was in third groups (55.56%), and there was no significant difference in the relationship between the types of adenocarcinoma of the esophagogastric junction and the lymph node metastasis rate (P0.05). In the lymph node metastasis degree, the lymph node metastasis degree from high to low was in the order of 2,1110,3,11,5,7,4,8,9, and the highest degree of metastasis was in the 2 group (48.). 72%) in.Siewert III, lymph node metastasis was from high to low, in group 2,3,11,7,6,5,1,9,8,4, among which the highest metastasis was in group 2 (80.95%). In lymph node metastasis, Siewert II and III were in group first (p=0.001), 2 group (p=0.015), and 6 group (p=0.03). Conclusion: Siewert II type and III type esophagogastric junction gland The clinicopathological features of cancer were significantly different; there was no statistical difference in the lymph node metastasis rate of the adenocarcinoma of the esophagogastric junction with different types. This may be associated with fewer cases. In this study, II type tumors were more susceptible to the metastasis of the lymph nodes beside the esophagus (110th groups) than the type Siewert III tumor. In the lymph node metastasis, the Siewert II type The tumor is more likely to appear in the cardiac right lymph node (first groups) (P0.05), while the Siewert III type tumor is more likely to appear in the cardiac left lymph node (second groups) (P0.05) lymph node metastasis, and there is a significant statistical difference between the two groups. Therefore, the Siewert II tumor is necessary to clean up 110 groups, 1 groups, Siewert III type tumor is necessary to clear the second groups of lymph nodes. Purpose: To explore Siewer The expression of PDZK1 and PDGFR- beta in the adenocarcinoma of the esophagogastric junction of t II and the interaction between them, and the difference in the expression of PDZK1 and PDGFR- beta in the adenocarcinoma of the esophagogastric junction and the distal gastric cancer of the Siewert II type. Methods: the specimens were collected from the paraffin block of the patients and made into paraffin sections to perform immunohistochemical staining. The positive rate of PDZK1 was 30% (12/40) in the adenocarcinoma of the esophagogastric junction, and the positive rate was 95% (38/40) in the normal tissues of the esophagogastric junction. The difference was statistically significant (x 2= 36.053, P0.001).PDGFR- beta in the adenocarcinoma of the esophagogastric junction, Zhongyang The positive rate of sexual expression was 80% (32/40), and the positive expression rate in the normal tissues of the esophagogastric junction was 28% (11/40). The difference was statistically significant (x 2=22.175, P0.001).PDZK1 and PDGFR- beta had no significant correlation (r=0.026, P=0.874) in the normal tissues of the esophagogastric junction (r=0.026, P=0.874). PDZK1 and PDGFR- beta had no significant correlation in the adenocarcinoma of the esophagogastric junction (r=0.111, P=0.49). 7. Compared to the distal gastric carcinoma, it was found that the expression of PDZK1 in the normal tissues of the gastroesophageal junction was higher than that of the distal gastric normal tissue (=-1.997, P=0.046), and the same expression of PDGFR- beta in the adenocarcinoma of the gastroesophageal junction was higher than that of the distal gastric carcinoma (=-3.811, P=0.000), and the difference was statistically significant. Conclusion: PDGFR- beta in the II esophagus of Siewert II esophagus stomach. The high expression of PDZK1 in normal tissues of Siewert II esophagogastric junction showed high expression of.PDZK1 and PDGFR- beta in the adenocarcinoma tissue and normal tissues of Siewert II esophagogastric junction. The expression of PDZK1 and PDGFR- beta in.Siewert II type esophagogastric junction was higher than that of the distal end. Combined with the clinical characteristics of gastric cancer, the adenocarcinoma of the esophagogastric junction may be a special type of tumor which is different from the distal gastric cancer, and PDZK1 may provide a certain reference value for the molecular typing and targeting therapy of AEG.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735

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