Kim Min A, Lee Hye Seung, Yang Han-Kwang, Kim Woo Ho
Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.
Cancer. 2005 Apr 1;103(7):1439-46. doi: 10.1002/cncr.20966.
Although the incidence of adenocarcinoma of the stomach has decreased over the past several decades, gastric cardia carcinoma has increased over the same period.
The clinicopathologic characteristics and immunohistochemical staining results of 21 proteins were investigated in 165 patients with cardia carcinoma, including 74 patients with true cardia carcinoma and 91 patients with subcardia carcinoma, and the results were compared with the results from 564 patients with noncardia carcinoma.
In the clinicopathologic analysis, patients who had cardia carcinoma tended to have tumors with poorly differentiated histology according to the World Health Organization classification system (P = 0.012), diffuse type according to the Lauren classification system (P = 0.049), and advanced pathologic TNM stage (P < 0.001). On immunohistochemical staining, loss of the p16 (P = 0.038) and smad4 (P < 0.001) tumor suppressor genes was more frequent in cardia carcinoma than in noncardia carcinoma. Carcinoembryonic antigen and CD44 overexpression were more frequent in patients with cardia carcinoma (P < 0.05). Conversely, patients who had cardia carcinoma exhibited less frequent expression of MUC1 (P = 0.008) and MUC5AC (P = 0.006) compared with patients who had noncardia carcinoma. Epstein-Barr virus infection was more common in patients with cardia carcinoma (P < 0.001). In the survival analysis, the patients with cardia carcinoma had a poorer prognosis. In the multivariate analysis, tumor location in the cardia was confirmed as an independent, poor prognostic factor in patients with gastric carcinoma.
Cardia carcinoma and noncardia carcinoma differed in their clinicopathologic characteristics and in their alterations of gene expression, as evaluated by immunohistochemistry. The current results support the hypothesis that cardia carcinoma forms a specific category of gastric carcinoma that is distinct from noncardia carcinoma.
尽管在过去几十年中胃癌腺癌的发病率有所下降，但同期贲门癌的发病率却有所上升。
对165例贲门癌患者（包括74例真性贲门癌患者和91例亚贲门癌患者）的21种蛋白质的临床病理特征和免疫组化染色结果进行了研究，并将结果与564例非贲门癌患者的结果进行了比较。
在临床病理分析中，根据世界卫生组织分类系统，贲门癌患者的肿瘤组织学分级往往较差（P = 0.012）；根据劳伦分类系统，为弥漫型（P = 0.049），且病理TNM分期较晚（P < 0.001）。在免疫组化染色中，与非贲门癌相比，贲门癌中p16（P = 0.038）和smad4（P < 0.001）肿瘤抑制基因的缺失更为常见。癌胚抗原和CD44的过表达在贲门癌患者中更为常见（P < 0.05）。相反，与非贲门癌患者相比，贲门癌患者中MUC1（P = 0.008）和MUC5AC（P = 0.006）的表达频率较低。爱泼斯坦 - 巴尔病毒感染在贲门癌患者中更为常见（P < 0.001）。在生存分析中，贲门癌患者的预后较差。在多变量分析中，贲门部肿瘤位置被确认为胃癌患者独立的不良预后因素。
通过免疫组化评估，贲门癌和非贲门癌在临床病理特征和基因表达改变方面存在差异。目前的结果支持贲门癌构成一种与非贲门癌不同的特定类型胃癌的假说。
