摘要
目的:通过对影响胃癌淋巴结转移因素的分析,探讨较准确预测胃癌有无淋巴结转移及其程度的标志.方法:采用RT-PCR技术检测62例胃癌患者原发癌组织中Heparanase,MMP-7,VEGF-C,S100A4,hRad17,hTERT,CDH1,KAI1和nm23H1基因的mRNA表达,结合系统的临床病理检查指标,运用BinaryLogisticregression进行多因素分析,寻找影响胃癌淋巴结转移的客观标志.结果:上述基因在胃癌组织中均有不同程度表达,其中S100A4和hTERT阳性率最高(96.8%),CDH1表达阳性率最低(64.5%).多因素分析表明淋巴管癌栓(P=0.009)和Heparanase表达(P=0.014)是判断有无淋巴结转移的独立因素,相对危险度分别为21.137和9.768.在预测胃癌淋巴结转移程度上(小于或等于6个为轻度转移,大于或等于7个为重度转移),Lauren分型和MMP-7,hTERT,CDHl基因表达是独立因素(P=0.012,0.037,0.009,0.021),其相对危险度分别为10.068,8.046,9.159,0.087,浆膜受侵面积亦是重要的影响因素.结论:胃癌组织中Heparanase高表达、淋巴管癌栓阳性者,有淋巴结转移的可能性较大;而组织学为弥漫型、浆膜受侵面积大于20cm2、原发癌灶中MMP-7、hTERT高表达、CDHl低表达者.淋巴结转移程度相对较重.术前检测上述基因mRNA表达并确定Lauren分型,术中结合胃浆膜受侵面积,对制定治疗方案有指导意义.
AIM: To analyze the factors influencing lymph node metastasis in gastric cancer and to screen the indicators that could predict more exactly the extent of lymph node metastasis before surgery. METHODS: The mRNA expression of heparanase, MMP-7, VEGF-C, S100A4, hRad17, hTERT, CDH1, KAI and nm23H1 genes were examined in 62 gastric cancer tissues by reverse transcription polymerase chain reaction (RT-PCR). In combination with clinicopathological features, univariate and multivariate analyses were carried out in order to screen the factors affecting lymph node metastasis of gastric carcinoma. RESULTS: All the genes above were expressed more or less in gastric cancer tissues. With regard to the positive rate, S100A4 and hTERT were the highest (both 96.8%) and CDH1 was the lowest (64.5%). Multivariate analysis with binary logistic regression showed that lymphatic invasion and heparanase mRNA expression were independent factors that judged whether there was lymph node metastasis, and the odds ratios [Exp (B)] were 21.137 (95% CI 2.115-211.211) and 9.768 (95% CI 1.582-60.300) respectively. When predicting the extent of the lymph node metastasis (the number of lymph node metastasis of no more than 6 was regarded as the fewer and lighter; no less than 7 as the more and heavier), MMP-7, hTERT and CDH1 genes mRNA expression and Lauren type of carcinoma were the independent factors (P=0.037, 0.009, 0.021 and 0.012 respectively), Exp (B) was 8.046, 9.159, 0.087 and 10.068 respectively. The area of serosa involvement was also an important factor. CONCLUSION: Heparanase mRNA expression and lymphatic invasion of gastric cancer tissue correlate with lymph node metastasis positively. The degree of lymph node metastasis is more serious in patients with diffusive histo-logical type, area of serosa involvement more than 20 cm2 and MMP-7, hTERT mRNA overexpression, and CDH1 loss of expression in gastric cancer. Above examinations before surgery are indicated to arrive at an optimum treatment scheme.
出处
《世界华人消化杂志》
CAS
2004年第2期266-270,共5页
World Chinese Journal of Digestology
基金
辽宁省自然科学基金项目
No.20022069~~
