Hong Seung-Mo, Kim Mi-Jung, Pi David Y, Jo Daniel, Yu Eunsil, Ro Jae Y
Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, South Korea.
Hum Pathol. 2005 Jul;36(7):732-40. doi: 10.1016/j.humpath.2005.05.002.
Neuroendocrine differentiation is known to be one of the prognostic factors in many carcinomas. However, the characteristics of neuroendocrine differentiation are not well elucidated in extrahepatic bile duct (EBD) carcinomas. One hundred ninety-four cases of EBD carcinomas were analyzed using immunohistochemistry with synaptophysin and chromogranin. The tumors were graded as degree 0, 1, and 2 when the positive tumor cells were 5% or less, 6% to 25%, and 26% or more, respectively. Immunohistochemical results were compared with clinicopathologic variables and survival rate. Synaptophysin and chromogranin were positive in 54 (27.8%) and 74 (38.1%) cases, respectively. Thirty-four cases (17.5%) were positive for both synaptophysin and chromogranin, 20 (10.3%) and 40 cases (20.6%) were positive only for synaptophysin and for chromogranin, respectively, and 100 cases (51.6%) were negative for both markers. There was a significant survival difference between overall synaptophysin-positive (median, 27 months) and synaptophysin-negative (38 months) groups (P < .05). However, there was no survival difference between chromogranin-positive and chromogranin-negative groups. There was a significant survival difference between the dual-positive expression to synaptophysin and chromogranin group (median, 21 months) and the dual-negative expression group (median, 35 months; P < .05). In summary, synaptophysin expression was an important prognostic factor because synaptophysin-positive cases showed a worse prognosis than synaptophysin-negative cases. The more tumor cells expressed chromogranin, the poorer the survival. Therefore, immunohistochemical studies for neuroendocrine differentiation may be helpful in routine pathological examinations for evaluating the survival and the prognosis of patients with EBD carcinomas.
神经内分泌分化是许多癌症的预后因素之一。然而，肝外胆管（EBD）癌中神经内分泌分化的特征尚未得到充分阐明。使用突触素和嗜铬粒蛋白免疫组织化学方法分析了194例EBD癌。当阳性肿瘤细胞分别为5%或更少、6%至25%、26%或更多时，肿瘤分级为0级、1级和2级。将免疫组织化学结果与临床病理变量和生存率进行比较。突触素和嗜铬粒蛋白分别在54例（27.8%）和74例（38.1%）中呈阳性。34例（17.5%）突触素和嗜铬粒蛋白均呈阳性，20例（10.3%）仅突触素呈阳性，40例（20.6%）仅嗜铬粒蛋白呈阳性，100例（51.6%）两种标志物均呈阴性。突触素总体阳性组（中位数为27个月）和突触素阴性组（38个月）之间存在显著的生存差异（P <.05）。然而，嗜铬粒蛋白阳性组和嗜铬粒蛋白阴性组之间没有生存差异。突触素和嗜铬粒蛋白双阳性表达组（中位数为21个月）和双阴性表达组（中位数为35个月；P <.05）之间存在显著的生存差异。总之，突触素表达是一个重要的预后因素，因为突触素阳性病例的预后比突触素阴性病例更差。表达嗜铬粒蛋白的肿瘤细胞越多，生存率越低。因此，神经内分泌分化的免疫组织化学研究可能有助于EBD癌患者生存和预后评估的常规病理检查。
