【作者】 张红凯；

【导师】 易永芬；

【作者基本信息】 重庆医科大学 ， 病理学， 2003， 硕士

【摘要】 目的：探讨MUC1、MUC2、MUC5AC和E-钙粘附素在胃癌组织中的表达及意义。方法：应用免疫组化S-P法，检测MUC1、MUC2、MUC5AC和E-钙粘附素在94例原发性胃癌标本中的表达。结果：1、MUC1在胃癌组织中阳性表达77例，阳性率82%，它在不同类型胃癌组织中表达不同（P<0.05），其中以在中高分化腺癌病例中表达比率最高，91%（30/33）；其表达程度与病人年龄、淋巴结有无转移及肿瘤大小密切相关（P<0.05），与病人性别、肿瘤发生部位、肿瘤浸润深度、有无胃外器官的累及、病人生存时间等无明显相关。2、MUC2在胃癌组织中阳性表达79例，阳性率84%，不同类型胃癌组织其表达不同（P<0.05），其中以在粘液腺癌中表达比率最高100%（7/7），且均为强阳性表达，在中高分化腺癌中的阳性率次之，94%（31/33）；其表达与本次研究的其它资料间无明显相关；COX分析表明它是对病人预后有显著影响的因素之一。3、MUC5AC的在胃癌组织中阳性表达38例，阳性率40%。胃癌不同类型间其阳性表达程度没有明显差异（P>0.05），除性别之间存在差异外，与所研究的其它因素间无显著的相关关系存在。4、E-cadherin胃癌组织中阳性表达53例，阳性率为56%。其表达与肿瘤分化有相关趋势，但与病人年龄、性别、肿瘤发生部位、有无淋<WP=5>巴结转移、肿瘤浸润深度、肿瘤大小、病人生存时间等无明显相关（P>0.05）。5、MUC1与MUC2和E-钙粘附素之间，MUC2与E-钙粘附素之间有显著的正相关关系存在（P<0.05）。6、COX分析表明，病人年龄、淋巴结转移、胃癌组织学类型以及MUC2的表达是对病人预后有显著性影响的几个因素。结论：1、MUC1在不同类型的胃癌组织中表达不同，在中高分化腺癌组织中表达最强，并与病人年龄、淋巴结转移、肿瘤大小有关；2、MUC2在不同类型的胃癌组织中表达不同，在粘液腺癌和中高分化腺癌中表达最强，可做为研究粘液腺癌和中高分化腺癌的较好指标；3、MUC5AC在胃癌组织中的表达比率较低，可能可作为研究胃癌发生、进展的较好指标；4、E-钙粘附素在不同类型的胃癌组织中表达没有明显差别，与病人的临床生物学特性方面也没有明显联系，但其表达与胃癌的管状分化有相关趋势；5、E-钙粘附素与MUC5AC在粘液腺癌中表达最低，MUC1与MUC2在粘液腺癌中表达较高，可能这两对指标在胃癌尤其是粘液腺癌的发生发展中起重要作用；5、MUC1、MUC2和E-钙粘附素间有明显的正相关关系。MUC1和MUC2可能抑制E-钙粘附素介导的肿瘤细胞的粘附功能，并且二者之间可能存在协同作用，从而有利于胃癌的进展。6、病人年龄、淋巴结转移、胃癌组织学类型以及MUC2的表达可作为判断病人预后的有用指标。更多还原

【Abstract】 OBJECTIVE：To investigate the significance of the expression of mucins (MUC1, MUC2, MUC5AC ) and E-cadherin in primary gastric cancers.METHODS: These proteins were detected by immuno-histochemistry S-P method. RESULTS: The rate of the MUC1 gene expression was 82% (77/94), MUC2 was 84%(79/94), MUC5AC gene expression was 40%(38/94) and E-cadherin was 56%(53/94).The expression of MUC1 was related with the different types of the cancer, patients’ age, involvement of the lymph nodes and the tumor size（P<0.05）; The MUC2 expression was significantly related with the different types of the cancer and had the strongest expression in mucinous carcinomas（P<0.05）, but it had no significant difference in patients’ age, gender ,the location of the tumor, involvement of the lymph nodes, the depth of gastric wall invasion and the metastasis to extra-gastric organs(P>0.05); MUC5AC expression was not related with any of the characteristics investigated at present except it had the difference in gender group(P<0.05) ,however, it had the tendency that it was higher in the less invasive gastric carcinoma tissues than it in the advanced tissues; As for the<WP=7>expression of E-cadherin, we didn’t find any significant difference in the present studied behaviors; Besides these findings mentioned above, there was strong positive relationship between MUC1 and E-cadherin, MUC2 and E-cadherin and MUC1 and MUC2. According to the COX proportional hazards model analysis, the advanced age of patients, the involvement of lymph nodes, the different types of gastric cancers and the MUC2 expression are significantly associated with poorer outcome of the gastric carcinoma patients. CONCLUSION: MUC1,MUC2 were good markers of different types of gastric cancer; MUC1 had the strongest expression in the well and moderately differentiated tubular carcinomas, and had a relationship with the interfered lymph nodes, tumor size and patients’ age; MUC2 was a excellent marker of mucinous carcinoma and well and moderately differentiated gastric cancers, it also had the independent role in predicting a poor prognosis of gastric cancer patients; MUC5AC may be a good marker in studying the progress of gastric carcinoma since it seemed decreased more in advanced gastric cancers; but the expression of E-cadherin had no clear relation with the cancer’s behaviors which were studied at present. Moreover, there was a positive relationship between MUC1 and E-cadherin, MUC2 and E-cadherin and MUC1 and MUC2, so MUC1 and MUC2 may have the synergic influence on the E-cadherin and MUC5AC’s function especially when we can see that in the mucinous cancers the expression of MUC1 and MUC2 were higher while the the MUC5AC and E-cadherin were lower, therefore MUC1 and MUC2 may contributed to the progress of the gastric cancer especially in mucinous gastric cancers.更多还原