【作者】 朱挺；

【导师】 张乐鸣；

【作者基本信息】 浙江大学 ， 肿瘤学， 2008， 硕士

【摘要】 目的:探讨大肠癌及其切缘组织中hTERT、SYK活性表达,从组织病理学和分子病理学水平探讨大肠癌在远、近端癌旁大肠组织中的浸润范围,探寻大肠癌远、近端癌旁肠壁的分子边界,为大肠癌根治术中远、近端癌旁肠壁的安全切缘确定提供依据。方法:收集我院20例大肠癌根治术病人的手术标本,分别采集新鲜大肠癌组织和癌旁1～5cm内每隔1cm的肠壁组织,如癌旁组织不足5cm,则取至手术切缘最远处为止。切取后投入10%福尔马林溶液中固定后制作成蜡块切片,行HE及免疫组化检查。用SABC、Supervion^TMSP免疫组化法分别检测检测大肠癌标本及其切缘组织中的hTERT、SYK活性的表达。结果:1.20例大肠癌标本中有6例hTERT表达阳性,9例强阳性表达,5例阴性表达,阳性表达率为75.00%,癌旁3cm、4cm、5cm处的切缘组织均无表达;hTERT的阳性表达从癌中心向癌旁1cm、2cm、3cm组织逐渐递减（p＜0.01）;远近端癌旁相同距离组织hTERT的阳性表达差异无统计学意义（p＞0.05）。2.SYK在20例大肠癌标本中有2例阳性表达,无强阳性表达,阳性率表达为10.00%,癌旁4cm切缘组织中SYK阳性表达率达75.00%;SYK的阳性表达从癌中心向癌旁1cm、2cm、3cm、4cm组织逐渐递增（p＜0.01）,癌旁4cm和5cm组织的阳性表达率差异无统计学意义（p＞0.05）;远近端癌旁相同距离组织SYK的阳性表达差异无统计学意义（p＞0.05）。3.常规病理HE染色切片,远端癌旁1cm组织有2例阳性,阳性率10.00%,近端癌旁1cm组织有1例阳性,阳性率5.00%;远端癌旁2cm组织有1例阳性,阳性率5.00%,近端癌旁2cm组织无1例阳性;远近端癌旁3cm、4cm、5cm组织无肿瘤浸润。结论:1.远近端切缘中肠壁组织肿瘤浸润距离均在3cm以内,大肠癌远、近端3cm处可作为大肠癌根治术的组织病理学切缘。2.hTERT在大肠癌肿瘤组织中高表达,SYK在大肠癌肿瘤组织中低表达或不表达,周围切缘组织中hTERT和SYK存在趋势性差异表达,且范围均在4cm以内,hTERT、SYK可作为大肠癌分子边界研究的分子标记物。3.分子病理学检测大肠癌切缘组织中肿瘤细胞浸润的方法优于组织病理学。组织病理学、分子病理学二者联合检测可提高检测的敏感性。4.hTERT和SYK在大肠癌周围组织中存在着分子边界,癌旁4cm可定为大肠癌安全切除的分子边界。更多还原

【Abstract】 Objective: To investigate the the expressions of human telomerase reverse transcriptase （hTERT） and Spleen tyrosine kinase （SYK） in the colorectal cancer and its surgical margin tissues. From histopathology and molecular pathology aspects,to study the infiltrated distance of tumor in the peripheral tissues, and to provide the evidence for evaluating the security of surgical margin in the radical operation of the colorectal cancer.Methods: 20 colorectal cancer patients who underwent radical operation were included in the study. Tumor tissue and the peripheral tissues within 5cm away from the tumor margin were collected from each fresh resected specimen,and the colorectal tissues within 5cm from the proximal and distal margin of the tumor was sliced transversely every 1cm. HE stained serial sections were made for the histopathologic examination. The expressions of hTERT and SYK were detected by the SABC and Supervion^TMSP immunohistochemistry in the colorectal cancer and its peripheral tissues 1cm、2cm、3cm、4cm and 5cm away from the tumor margin.Results:1. Found microscopically, among 20 specimens of colorectal cancer,there were 6 positive expression specimens,9 strong positive expression specimens and 5 negative expression specimens of hTERT. The positive ratio was 75.00%.There was no hTERT expression in tissues 3cm,4cm and 5cm away from the tumor margin. The result of immunochemical staining showed that hTERT positive expression indicated a tendency of decreasing current from tumor tissue to peripheral tissues 1cm,2cm and 3cm from tumor margin（p<0.01）. hTERT positive expression ratio in equal distance of proximal and distal margin represented no statistical significance （p>0.05） .2. Among 20 specimens of colorectal cancer,there were 2 positive expression specimens and no strong positive expression specimens of SYK .The positive ratio was 10.00%. The positive ratio of SYK expression in tissues 4 cm from the tumor margin was 75.00%. The result of immunochemical staining showed that SYK positive expression indicated a tendency of increasing current from tumor tissue to peripheral tissues 1cm,2cm,3cm and 4cm from tumor margin （p<0.01）. SYK positive expression ratio in peripheral tissues 4cm and 5cm from tumor margin represented no statistical significance （p>0.05） .SYK positive expression ratio in equal distance of proximal and distal margin represented no statistical significance （p>0.05） .3. The tumor infiltration in proximal and distal margin 1cm away from tumor margin were 1 of 20 patients （5.00%） and 2 of 20 patients （10.00%）, respectively, the tumor infiltration in proximal and distal margin 2cm away from tumor margin were 0 of 20 patients （0.00%） and 1 of 20 patients （5.00%）.There was no tumor infiltration in tissues 3cm,4cm and 5cm from tumor margin.Conclusions1. The pathologic infiltration along the proximal and distal margin was within 3cm.3cm proximal and distal to the tumor may be the histopathologic margin in the radical operation for colorectal cancer.2. The expression of hTERT in the colorectal cancer were high, The expression of SYK in the colorectal cancer were low or even deletion. The distance of high expression of hTERT and low expression of SYK were all within 4cm. hTERT and SYK were correlated with the genesis,development, infiltration and metastasis. hTERT and SYK were good molecular markers for the study of surgical margin in the radical operation3.Molecular pathology is superior to histopathology in detecting infiltration. Sensitivity in the detecting would be elevated when two methods combined.4. The differential expression of hTERT and SYK in cololectal cancer tissue and its surrounding tissues indicate the presence of molecular margin around cololectal cancer tissue. Considering hTERT and SYK expressions, 4 cm can be defined as safe molecular margin of the radical operation of cololectal cancer.更多还原