食管癌伴神经内分泌分化的临床病理特点及诊断标志物  

Clinico-pathological characteristics and diagnostic biomarkers in patients with esophageal carcinoma accompanied by neuroendocrine cell differentiation

作　　者：刘连科[1] 邵明雯[2] 马兰[1] 孙婧[1] 管丹[1] 束永前[1] 

机构地区：[1]南京医科大学第一附属医院肿瘤科,江苏南京210029 [2]武警江苏省总队医院内科,江苏扬州225003

出　　处：《山东大学学报（医学版）》2015年第7期87-91,共5页Journal of Shandong University:Health Sciences

基　　金：江苏省高校优势学科建设工程资助项目(JX10231801);中国高校医学期刊临床专项资金(11520112)

摘　　要：目的探讨食管癌伴神经内分泌分化(E-NED)的临床病理特点及诊断标志物。方法回顾性分析2008年1月至2013年12月经病理证实的低分化食管癌378例患者的临床病理资料,其中无NED(E-NNED)349例,E-NED 29例,免疫组织化学检测29例E-NED以及随机选取20例E-NNED患者肿瘤组织中突触素(Syn)、嗜铬蛋白A(Cg A)、神经元特异性烯醇化酶(NSE)、神经细胞黏附分子(CD56)、蛋白基因产物9.5(PGP9.5)、促泌素(SCGN)、甲状腺转录因子1(TTF-1)的表达。结果 E-NED与E-NNED患者的年龄、性别、病变长度等临床病理因素差异均无统计学意义(P>0.05)。除TTF-1外,E-NED患者的Syn、Cg A、NSE、CD56、PGP9.5及SCGN表达均高于E-NNED患者(P<0.05)。在联合检测中,Syn分别与CD56、PGP9.5或SCGN构成的3种组合敏感性、阳性预测值及诊断正确率均高于Syn+Cg A组合(P<0.05)。E-NED与E-NNED患者的1、2、3年生存率差异无统计学意义(P>0.05)。结论 E-NED与E-NNED可能是不同的食管癌病理类型,PGP9.5、SCGN均可作为E-NED的诊断标志物,Syn与CD56、PGP9.5或SCGN联合检测可提高诊断敏感性和正确率。Objective To investigate the clinico-pathological characteristics and diagnostic markers in esophageal carcinoma accompanied by neuroendocrine cell differentiation（ E-NED）. Methods The clinico-pathological data of 378 patients with poorly differentiated esophageal carcinoma from Jan. 2008 to Dec. 2013,including 349 without neuroendocrine differentiation（ E-NNED） and 29 with neuroendocrine differentiation（ E-NED）,were retrospectively analyzed.The expressions of synaptophysin（ SYN）,chromogranin A（ Cg A）,neuron-specific enolase（ NSE）,neural cell adhesion molecule（ CD56）,protein gene product（ PGP9. 5）,secretagogin（ SCGN） and thyroid transcription factor 1（ TTF-1） in the esophageal carcinoma tissues of 29 patients with E-NED and 20 ones randomly selected from the 349 patients with E-NNED were detected using immunohistochemistry. Results There were no significant differences between the patients with E-NED and E-NNED in terms of the age,gender,length of lesion and other clinico-pathological factors. Except for TTF-1,the expressions of Syn,Cg A,NSE,CD56,PGP9. 5 and SCGN were significantly higher in patients with E-NED than those with E-NNED（ P〈0. 05）. The sensitivity,positive predictive value anddiagnostic accuracy were all higher in the combined detection of Syn and CD56,PGP9. 5 or SCGN than Syn and Cg A（ P〈0. 05）. There were no significant differences between the patients with E-NED and E-NNED regarding 1,2 and3-year survival rates. Conclusion E-NED and E-NNED may be different pathological types of esophageal carcinoma.Both PGP9. 5 and SCGN can be considered as the diagnostic markers of E-NED,and the combined detection of Syn and CD56,PGP9. 5 or SCGN can improve the sensitivity and diagnostic accuracy.

关 键 词：食管癌 神经内分泌分化 预后 突触素 神经细胞黏附分子 蛋白基因产物9.5 促泌素 

分 类 号：R735.1[医药卫生—肿瘤]