Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Tokyo, Japan.
Br J Cancer. 2013 Jul 23;109(2):379-86. doi: 10.1038/bjc.2013.314. Epub 2013 Jun 18.
Multiple early gastric cancers (EGCs) may develop in 6-14% of patients even after achieving curative endoscopic submucosal dissection (ESD); however, a useful biomarker for predicting recurrence is not available. The present study investigated whether the expression of CD44 variant 9 (CD44v9), a functional cancer stem cell marker, in the primary gastric cancer tissue represents an indicator of recurrence.
Eighty-eight patients who underwent ESD for EGC from 2008 to 2010 were enrolled and monitored for recurrence for 3 years. The expression levels of CD44v9 in the tissue of initial EGCs were evaluated by immunohistochemistry, and the recurrence rate was compared between CD44v9-positive and CD44v9-negative groups. The mucin phenotype and expression of microRNA-21 (miR-21) and programmed cell death protein 4 (PDCD4) were also analysed.
The recurrence rate of EGC was significantly higher in the CD44v9-positive group than in the CD44v9-negative group (hazard ratio (HR), 21.8; 95% confidence interval (CI), 5.71-83.1). However, mucin phenotypes and the expression of miR-21 and PDCD4 did not predict recurrence after ESD. Meanwhile, grade of gastric atrophy was also identified as a significant marker of multiple recurrence (HR, 4.95; 95% CI, 1.30-18.8).
CD44 variant 9 expression represents a potential predictive marker for recurrence in EGC.
即使在达到根治性内镜黏膜下剥离术（ESD）后，仍有 6-14%的患者可能会出现多个早期胃癌（EGC）；然而，目前还没有可用的预测复发的有用生物标志物。本研究探讨了原发性胃癌组织中 CD44 变体 9（CD44v9）的表达是否代表复发的指标，CD44v9 是一种功能性癌症干细胞标志物。
纳入 2008 年至 2010 年接受 ESD 治疗 EGC 的 88 例患者，并进行 3 年的复发监测。通过免疫组织化学评估初始 EGC 组织中 CD44v9 的表达水平，并比较 CD44v9 阳性和 CD44v9 阴性组的复发率。还分析了粘蛋白表型以及 microRNA-21（miR-21）和程序性细胞死亡蛋白 4（PDCD4）的表达。
CD44v9 阳性组的 EGC 复发率明显高于 CD44v9 阴性组（危险比（HR），21.8；95%置信区间（CI），5.71-83.1）。然而，粘蛋白表型以及 miR-21 和 PDCD4 的表达并不能预测 ESD 后的复发。同时，胃萎缩的程度也被确定为多发复发的显著标志物（HR，4.95；95% CI，1.30-18.8）。
CD44 变体 9 的表达代表 EGC 复发的潜在预测标志物。
