Choi Ji Eun, Noh Sang Jae, Lee Ju Hyung, Bae Jun Sang, Chu Hyun Hee, Park Ho Sung, Jang Kyu Yun, Chung Myoung Ja, Kang Myoung Jae, Lee Dong Geun, Moon Woo Sung
Department of Pathology, Chonbuk National University, Medical School and Research Institute for Endocrine Sciences, Jeonju, Jeonbuk 561-756, Republic of Korea.
Oncol Lett. 2012 Sep;4(3):534-540. doi: 10.3892/ol.2012.756. Epub 2012 Jun 13.
Although the expression of keratin 7 (K7) and K20 is considered to be a useful factor in the differential diagnosis of intrahepatic cholangiocarcinoma (ICC) and metastatic colorectal carcinoma (CRC) of the liver, a proportion of typical ICC retains K20 expression. The frequency and biological significance of K20 expression in ICC remains unclear. We analyzed the expression of K7, K19 and K20 in 66 surgically resected liver tumors consisting of 46 ICCs and 20 metastatic CRCs of the liver and 20 corresponding primary CRCs. In the 46 ICCs, K7, K19 and K20 were expressed in 40 (87%), 45 (98%) and 16 (35%) cases, respectively. K7, K19 and K20 were expressed in 1 (5%), 20 (100%) and 16 (80%) of the 20 primary CRCs and 2 (10%), 20 (100%) and 16 (80%) of the 20 metastatic CRCs, respectively. A combined K7/K20 profile was identified as a good predictor for differentiating ICC and metastatic CRC. K20 expression in ICC was significantly associated with male gender (P=0.034), hilar location (P=0.026), intraductal papillary type (P=0.006), intestinal phenotype (P<0.001) and MUC2 expression (P=0.008). Univariate analysis identified that poor patient survival was significantly associated with histological grade (P=0.020), invasion depth (P=0.005), lymph node metastasis (P=0.012), tumor stage (P=0.004) and vessel invasion (P=0.023). The tumor stage (P=0.002) was a poor independent prognostic indicator, while MUC6 expression (P=0.036) was a good independent prognostic indicator. The survival rate in patients with K20-positive ICC was lower compared to that of patients with K20-negative ICC, but was not statistically significant. Furthermore, the combined K7/K20 immunophenotype was identified to be useful for differentiating ICC and metastatic CRC. K20-positive ICC displays specific characteristics with regards to tumor location and histological subtype. Additionally, MUC6 expression in ICC is a good independent prognostic factor, while K20 expression is more often associated with aggressive biological behavior.
尽管角蛋白7（K7）和K20的表达被认为是肝内胆管癌（ICC）与肝转移性结直肠癌（CRC）鉴别诊断中的一个有用因素，但一部分典型的ICC仍保留K20表达。K20在ICC中表达的频率及生物学意义尚不清楚。我们分析了66例手术切除的肝肿瘤中K7、K19和K20的表达情况，这些肿瘤包括46例ICC、20例肝转移性CRC以及20例相应的原发性CRC。在46例ICC中，K7、K19和K20分别在40例（87%）、45例（98%）和16例（35%）中表达。在20例原发性CRC中，K7、K19和K20分别在1例（5%）、20例（100%）和16例（80%）中表达；在20例转移性CRC中，K7、K19和K20分别在2例（10%）、20例（100%）和16例（80%）中表达。K7/K20联合表达模式被确定为鉴别ICC和转移性CRC的良好预测指标。ICC中K20的表达与男性性别（P = 0.034）、肝门部位置（P = 0.026）、导管内乳头状类型（P = 0.006）、肠型（P < 0.001）及MUC2表达（P = 0.008）显著相关。单因素分析表明，患者生存预后差与组织学分级（P = 0.020）、浸润深度（P = 0.005）、淋巴结转移（P = 0.012）、肿瘤分期（P = 0.004）及血管侵犯（P = 0.023）显著相关。肿瘤分期（P = 0.002）是不良的独立预后指标，而MUC6表达（P = 0.036）是良好的独立预后指标。K20阳性ICC患者的生存率低于K20阴性ICC患者，但差异无统计学意义。此外，K7/K20联合免疫表型被确定可用于鉴别ICC和转移性CRC。K20阳性ICC在肿瘤位置和组织学亚型方面表现出特定特征。此外，ICC中MUC6表达是良好的独立预后因素，而K20表达更常与侵袭性生物学行为相关。
