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腹膜转移胃癌的临床病理特征和相关机制研究

李熳1,张志广1,夏秀丽2,季英兰1   

  1. 1. 天津医科大学第二医院
    2. 天津医科大学
  • 收稿日期:2011-06-20 修回日期:2011-11-08 出版日期:2012-05-15 发布日期:2012-05-15
  • 通讯作者: 张志广

A study on Clinicopathologic Significance and Mechanism of Peritoneal Metastasis in Gastric Cancer

  • Received:2011-06-20 Revised:2011-11-08 Published:2012-05-15 Online:2012-05-15

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摘要： 摘要 目的: 探讨发生腹膜转移 (peritoneal metastasis, PM) 胃癌的临床病理学特征，通过对缺氧诱导因子-1 a (hypoxia-inducible factor-1a, HIF-1a)、黏着斑激酶 (focal adhesion kinase，FAK) 和金属基质蛋白酶-9（Matrix Metalloproteinase，MMP-9）的免疫组化染色，初步探讨腹膜转移的机制。 方法: 收集164例临床资料和随访资料完整的胃癌病例，将其分成腹膜转移组和无腹膜转移组，并进行HIF-1a、FAK和MMP-9的免疫组化染色。结果: 164例胃癌患者中发生腹膜转移者41例 (25 %)，弥漫型胃癌 (diffuse-type gastric cancer, DGC)较肠型胃癌 (intestinal-type gastric cancer, IGC) 更易发生腹膜转移， Kaplan-Meier生存分析显示腹膜转移组的生存率低于无腹膜转移组 (P=0.000)， Cox回归模型显示TNM分期和腹膜转移是影响胃癌患者生存率的危险因素。腹膜转移组HIF-1a、FAK和MMP-9的表达均高于无腹膜转移组(P均<0.05)。结论: 腹膜转移是影响胃癌预后的重要因素之一，其与胃癌的浸润深度，TNM分期相关，弥漫型胃癌更易发生腹膜转移。缺氧可能在胃癌的腹膜转移中发挥了重要的作用。

关键词: 腹膜转移, 弥漫型胃癌, 肠型胃癌, 缺氧诱导因子-1

Abstract: Abstract Objective: To investigate the clinicopathologic significance of peritoneal metastasis (PM) in gastric cancer. We tend to illuminate the mechanism of peritoneal metastasis by performing the immunohistochemical staining of HIF-1a、FAK and MMP-9. Method: 164 gastric cancer samples with detailed follow-up data were collected. Immunohistochemical staining of HIF-1a、FAK and MMP-9 were performed for all samples. Result: PM was observed in 41 of the 164 GAC patients, especially in diffuse-type gastric cancer (DGC) (P=0.019). The Kaplan-Meier survival analysis showed that the survival duration of the PM-positive group was significantly shorter than that of PM-negative group (P=0.000). Cox proportional hazards model indicated that the PM and TNM stage were independent predictors of poor prognosis for GAC. The immunohistochemical expression of HIF-1a、FAK and MMP-9 were all higher in the PM-positive group than in the PM-negative group (P<0.05 for all). Conclusion: PM is an unfavorable prognostic indictor for gastric cancer which was associated with infiltrating depth and TNM stage. DGC tend to have peritoneal metastasis easily. Hypoxia might play a role in the formation of PM in gastric cancer.

Key words: peritoneal metastasis, diffuse-type gastric cancer, intestinal-type gastric cancer, hypoxia-inducible factor-1a