Driessen A, Nafteux P, Lerut T, Van Raemdonck D, De Leyn P, Filez L, Penninckx F, Geboes K, Ectors N
Department of Pathology, University Hospital Maastricht, The Netherlands.
Mod Pathol. 2004 Jan;17(1):49-55. doi: 10.1038/modpathol.3800011.
Surgical treatment and prognosis is different in esophageal, cardiac and distal gastric adenocarcinomas. Determination of the origin, in particular of adenocarcinomas situated at the gastroesophageal junction, may be difficult. It has been suggested that esophageal adenocarcinomas are characterized by a specific cytokeratin pattern, namely the CK7+/CK20- pattern. According to the same authors, this cytokeratin pattern is absent in gastric adenocarcinomas. The aim of our study is to evaluate if this cytokeratin pattern CK7+/CK20- is absent in cardiac and distal gastric adenocarcinomas. Therefore, we evaluated the combined immunohistochemical expression of CK7 and CK20 on paraffin-embedded material of 214 resection specimens for adenocarcinoma, comprising 66 esophageal, 73 cardiac and 75 distal gastric adenocarcinomas (UICC-classification). The adenocarcinomas were subtyped into intestinal- and diffuse-type according to the Lauren classification. The immunohistochemical staining was considered as positive if 50% or more of the tumor cells were stained. Statistical analysis has been performed applying the chi2-test. The tumors situated at the gastroesophageal junction, esophageal as well as cardiac adenocarcinomas, showed predominantly a CK7+/CK20- expression pattern (67 vs 68%), whereas this cytokeratin pattern is rather uncommon in distal gastric adenocarcinomas (31%, P<4 x 10(-5)). Independent of their localization, intestinal- as well as diffuse-type adenocarcinomas have a similar cytokeratin pattern. Our data show that the combined expression of CK7 and CK20 is different for the adenocarcinomas situated on both sides of the gastroesophageal junction compared to the distal gastric adenocarcinomas. However, in contrast to data in the literature, the combined expression of CK7 and CK20 has a low specificity in the distinction between esophageal and cardiac adenocarcinomas. This may suggest a similar origin (cell lineage) and thus may have an impact on therapeutic strategies.
食管、贲门和远端胃腺癌的手术治疗及预后有所不同。确定肿瘤起源，尤其是位于胃食管交界处的腺癌的起源，可能存在困难。有人提出食管腺癌具有特定的细胞角蛋白模式，即CK7+/CK20-模式。据同一批作者称，这种细胞角蛋白模式在胃腺癌中不存在。我们研究的目的是评估CK7+/CK20-这种细胞角蛋白模式在贲门和远端胃腺癌中是否不存在。因此，我们评估了214例腺癌切除标本石蜡包埋材料上CK7和CK20的联合免疫组化表达，这些标本包括66例食管腺癌、73例贲门腺癌和75例远端胃腺癌（国际抗癌联盟分类）。根据劳伦分类法，将腺癌分为肠型和弥漫型。如果50%或更多的肿瘤细胞被染色，则免疫组化染色被视为阳性。采用卡方检验进行统计分析。位于胃食管交界处的肿瘤、食管腺癌以及贲门腺癌，主要表现为CK7+/CK20-表达模式（分别为67%和68%），而这种细胞角蛋白模式在远端胃腺癌中相当少见（31%，P<4×10⁻⁵）。无论其位置如何，肠型和弥漫型腺癌具有相似的细胞角蛋白模式。我们的数据表明，与远端胃腺癌相比，胃食管交界处两侧的腺癌中CK7和CK20的联合表达有所不同。然而，与文献数据相反，CK7和CK20的联合表达在区分食管腺癌和贲门腺癌方面特异性较低。这可能提示它们有相似的起源（细胞谱系），因此可能对治疗策略产生影响。
