影响涎腺导管癌预后的临床病理因素和免疫组化标记物  

Clinicopathological Factors and Biomarker Immunoprofile Affecting Prognosis of Salivary Ductal Carcinoma

作　　者：宝鲁日 施琳[1,2] BAO Luri;SHI Lin(Department of Pathology,Inner Mongolia Medical University,Hohhot 010010,China;Department of Pathology,Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010010,China)

机构地区：[1]内蒙古医科大学基础医学院病理教研室,内蒙古呼和浩特010010 [2]内蒙古医科大学附属医院病理科,内蒙古呼和浩特010010

出　　处：《口腔医学研究》2024年第11期1013-1018,共6页Journal of Oral Science Research

基　　金：2022年内蒙古自然科学基金(项目号:2022 LHMS08003)。

摘　　要：目的:探讨影响涎腺导管癌(salivary duct carcinoma, SDC)患者预后的临床病理因素和免疫组化标记物。方法:回顾性分析23例SDC患者的临床资料并进行随访,采用苏木精-伊红(hematoxylin-eosin, HE)染色、免疫组织化学染色和人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)银染原位杂交(silver-enhanced in situ hybridization, SISH)检测,并进行生存回归分析。结果:23例SDC患者中男性20例,女性3例;发病年龄39~86岁,平均年龄63.91岁;15例肿瘤发生于腮腺,8例发生于颌下腺;随访结果,术后4例复发,4例死亡,其余患者生存良好,中位随访时间43个月。肿瘤组织呈导管内筛状、巢状、实性、腺管状、条索状。在筛孔状及实性结构的中心可见粉刺样坏死。瘤细胞较大,胞浆嗜酸性、颗粒状,胞核大、多形性,核仁明显,染色质粗,核分裂像易见。免疫表型:CK7(23/23);雄激素受体(androgen receptor, AR)(21/23);巨囊性病液体蛋白15(giant cystic disease liquid protein, GCDFP15)(17/23);p53(16/23);CK5/6(11/23);HER2(10/23),GATA结合蛋白3(GATA binding protein 3,GATA3)(10/23);CK14(3/23);p63(2/23)。不表达S-100,Ki-67增殖指数5%~80%。从免疫组织化学标记物和临床病理特征的关系,CK5/6阳性患者临床分期多为Ⅲ/Ⅳ期(P=0.009),而AR、HER2、GATA3、Ki-67增殖指数与患者的临床病理特征相关性无统计学意义(P>0.05)。单因素、多因素生存分析结果显示临床分期是影响患者OS的危险因素(P=0.042)。结论:SDC侵袭性强,易复发和转移,CK5/6阳性患者预后不佳。Objective:To explore the clinicopathological factors and biomarker immunoprofile affecting the prognosis of salivary ductal carcinoma.Methods:Retrospective analysis was applied on 23 cases of salivary ductal carcinoma including follow-up record and other clinical data collected.HE staining,immunohistochemical MaxVision two-step staining,and HER2(HER2/Neu)gene amplification investigated by SISH were performed.Overall survival(OS)were analyzed with Kaplan-Meier curves and Cox regression.Results:Twenty-one were males and 2 were females,with an average age of 63.91 years old(39-86 years old).Tumors occurred in the parotid gland(15 cases)and submandibular gland(8 cases).Follow-up revealed 4 cases of mortality and 4 cases of relapse,while the remaining patients were survival without recurrence after surgery.The mean follow-up time was 42 months.The tumor tissue appears as heterogeneous patterns including intraductal cribriform,nest,solid,glandular tubular,and cord like structure.Acne-like necrosis was observed at the central area of the cribriform-like and solid structure.Tumor cells displayed large size,eosinophilic and granular cytoplasm,prominent and polymorphic nuclei,obvious nucleoli,dense chromatin,and visible mitotic figures.Immunophenotype was CK7(23/23),AR(21/23),giant cystic disease liquid protein(GCDFP-15)(17/23),p53(16/23),CK5/6(11/23),HER2(10/23),GATA3(10/23),CK14(3/23),and p63(2/23).S-100 was not expressed.Ki-67 proliferation index ranged from 5%to 80%.CK5/6-positive cases were more often diagnosed at tumor stageⅢ/Ⅳ(P=0.009),while AR,HER2,GATA3,and Ki-67 proliferation indices were not related to the clinicopathological characteristics of patients(P>0.05).Univariate and multivariate survival analyses showed that clinical staging was a risk factor for OS in patients(P=0.042).Conclusion:Salivary ductal carcinoma is highly invasive,prone to recurrence and metastasis.CK5/6-positive is a potential biomarker of poor outcome in SDC.

关 键 词：导管癌 涎腺肿瘤 临床病理 免疫组化标记物 预后 

分 类 号：R739.8[医药卫生—肿瘤]