Tezel E, Nagasaka T, Nomoto S, Sugimoto H, Nakao A
Department of Surgery II, Nagoya University, School of Medicine, Japan.
Cancer. 2000 Dec 1;89(11):2230-6. doi: 10.1002/1097-0142(20001201)89:11<2230::aid-cncr11>3.0.co;2-x.
The accurate estimation of the rate and the clinicopathologic significance of neuroendocrine-like differentiation (NED) in patients with pancreatic carcinoma have not been studied in detail.
Forty-four patients with pancreatic carcinoma who underwent surgical resection at the Department of Surgery II, Nagoya University Hospital, were included in this study. For immunostaining, antibodies against neural cell adhesion molecule (NCAM), neuron-specific enolase (NSE), synaptophysin, CD57, and chromogranin A (CGA) were used at given dilutions. At least two positive results with antibodies were considered as NED. Statistical analysis was performed by chi-square and Spearman rank correlation tests for group differences. Survival rates were calculated by the Kaplan-Meier method, and statistical significance was examined using the log rank test. Prognostic factors were tested by univariate and multivariate analyses (proportional hazards regression model). P < 0.05 was considered statistically significant.
Of 44 patients examined, 20 showed NED. The distribution of patients with positive or negative NED in terms of age, tumor differentiation, tumor size, and the extent of tumor or lymph node metastasis showed no significant difference. The cumulative survival rates of patient groups according to NED status were then calculated, and NED positive patients showed a significantly better survival rate (P < 0.05). Univariate and multivariate analyses of those factors showed that only NED status and TNM stage were significantly related to overall survival.
The current study suggests the significance of NED status in determining the outcome of patients with pancreatic adenocarcinoma, giving solid evidence to encourage further studies on the differentiation and origin of tumor cells in the pancreas.
胰腺癌患者神经内分泌样分化（NED）的发生率及其临床病理意义尚未得到详细研究。
本研究纳入了44例在名古屋大学医院第二外科接受手术切除的胰腺癌患者。免疫染色时，按照给定稀释度使用抗神经细胞黏附分子（NCAM）、神经元特异性烯醇化酶（NSE）、突触素、CD57和嗜铬粒蛋白A（CGA）的抗体。抗体检测结果至少有两项为阳性则视为存在NED。采用卡方检验和Spearman秩相关检验进行组间差异的统计学分析。采用Kaplan-Meier法计算生存率，并使用对数秩检验检验统计学显著性。通过单因素和多因素分析（比例风险回归模型）对预后因素进行检验。P < 0.05被认为具有统计学显著性。
在44例接受检查的患者中，20例显示存在NED。NED阳性和阴性患者在年龄、肿瘤分化程度、肿瘤大小以及肿瘤或淋巴结转移范围方面的分布无显著差异。随后计算了根据NED状态分组的患者累积生存率，NED阳性患者的生存率显著更高（P < 0.05）。对这些因素进行单因素和多因素分析显示，只有NED状态和TNM分期与总生存期显著相关。
本研究表明NED状态在决定胰腺腺癌患者预后方面具有重要意义，为鼓励进一步研究胰腺肿瘤细胞的分化和起源提供了有力证据。
