【作者】 张超；

【导师】 胡祥；

【作者基本信息】 大连医科大学 ， 外科学， 2010， 硕士

【摘要】 目的：观察家族性胃癌的临床病理特点。检测桥粒芯糖蛋白2在家族性胃癌中的表达,探讨其与家族性胃癌的发生、发展关系。方法：对大连医科大学附属第一医院1998-2008年间的34例家族性胃癌、随机选取的同期100例散发性胃癌进行病例回顾分析,观察两组的临床病理差异。通过免疫组化方法,检测桥粒芯糖蛋白2在34例家族性胃癌和随机选取的34例散发性胃癌中的表达情况。结果：家族性胃癌病例与散发性胃癌病例临床资料对比显示：在年龄、浸润深度、临床分期、组织分化、Lauren分型、淋巴结阳性率和淋巴结转移范围方面,家族性胃癌和散发性胃癌有显著差异(p均<0.05)。而在肿瘤部位(p=0.440)肿瘤大小(p=0.315)方面,无统计学差异。生存分析显示家族性胃癌病人生存率显著低于散发性胃癌(p<0.05)。多因素分析显示年龄、浸润深度、组织学分型、Lauren分型、肿瘤分期是影响家族性胃癌的独立因素(p均<0.05),性别(p=0.421)、肿瘤部位(p=0.315)、淋巴结阳性率(p=0.841)和Dsg2的表达样式(p=0.351)不是独立因素。免疫组化分析显示34例家族性胃癌中有13例正常表达,9例中度异常表达,12例重度异常表达。34例对照的散发性胃癌中有24例正常表达,6例中度异常表达,4例重度异常表达。Dsg2表达在家族性胃癌与散发性胃癌之间、弥漫型胃癌和肠型胃癌之间有显著差异(p均<0.05),但在家族性弥漫型和散发性弥漫型胃癌间(p=0.352)、家族性肠型和散发性肠型胃癌间(p=0.415)无显著差异。在家族性胃癌中,Dsg2的表达与肿瘤大小和组织分化有关(p均<0.05)。与年龄(p=1.000)、性别(p=1.000)、肿瘤部位(p=0.290)、临床分期(p=0.077)、浸润深度(p=0.450)和淋巴结转移(p=0.932)无相关性。结论：家族性胃癌的临床病理特点有：发病年龄早：组织分化差,多为弥漫型：淋巴转移早,转移率高；发展迅速,预后差。Dsg2在家族性胃癌患者和弥漫型胃癌患者中有显著的表达下调,是家族性胃癌发病机制的一部分,并且与肿瘤的增长和发展有关。更多还原

【Abstract】 Objective:This study was to observe familial clinical and pathological characteristics of familial gastric cancer, examine the expression of desmoglein 2 in familial gastric cancer and investigate the relationship between desmoglein 2 and development and invasion in familial gastric cancer.Methods:We retrospectively analyzed 34 cases of familial gastric cancer and 100 cases of sporadic gastric cancer which were randomly selected to observe the differences between the two teams in clinical and pathology. Immunohistochemical method was used to detect the protein expression of desmoglein 2 in 34 cases of familial gastric cancer and 34 cases of sporadic gastric cancer which were randomly selected. All cases were collected in the first affiliated hospital of Dalian medical university from 1998 to 2008.Results:Comparing the clinical data of familial gastric cancer cases and sporadic gastric cancer show:There were significant differences between familial and sporadic gastric cancer in age, depth of invasion, clinical stage, histological type, Lauren type, lymph node-positive rate and the scope of lymph node metastasis (p<0.05).There were not significant difference in the tumor site (p=0.440) and tumor size (p=0.315). Survival analysis showed that the familial gastric cancer patient survival rate was significantly lower than in sporadic gastric cancer (p<0.05). Multivariate analysis showed that age, depth of invasion, histological type, Lauren type, tumor stage was independent factors in familial gastric cancer (p<0.05), while gender (p=0.421), tumor location (p=0.315), node-positive rate (p= 0.841) and the expression of Dsg2 style 0=0.351) are not independent factors. Immunohistochemical analysis showed that 13 cases of normal expression,9 cases of abnormal expression of moderate and 12 cases of severe abnormal expression in 34 cases of familial gastric cancer. There were 24 cases of normal expression,6 cases of abnormal expression of moderate,4 cases of abnormal expression in 34 cases of sporadic gastric cancer. The expression pattern of Dsg2 was significantly different between familial gastric cancer and sporadic gastric cancer, diffuse and intestinal type of gastric cancer (p<0.05).However, there were no significant differences between familial diffuse gastric cancer and sporadic diffuse gastric cancer (p=0.352), familial intestinal type of gastric cancer and sporadic intestinal gastric intestinal(p=0.415).In familial gastric cancer, the expression pattern of Dsg2 was related with tumor size and histological type (p<0.05),while not related with age (p=1.000), gender (p=1.000), tumor location (p=0.290), clinical stage (p=0.077), depth of invasion (p= 0.450) and lymph node metastasis(p=0.932).Conclusions:Familial gastric cancer clinical and pathological characteristics were:early age of onset; poor histological type, more diffuse type; earlier lymph node metastasis, high rate of transfer; rapid development and poor prognosis. The expression of Dsg2 significantly decrease in patients of familial gastric cancer and diffuse gastric cancer, which play a role in the mechanism of familial gastric cancer, especially in the growth and development of tumor.更多还原