Department of Pathology, Dokkyo Medical University Koshigaya Hospital, Saitama 343-8555, Japan.
World J Gastroenterol. 2013 Jul 7;19(25):3957-68. doi: 10.3748/wjg.v19.i25.3957.
AIM: To investigate mucin expression profiles in colorectal carcinoma (CRC) histological subtypes with regard to clinicopathologic variables and prognosis. METHODS: Mucin (MUC)2 and MUC5AC expressions were assessed by immunohistochemistry for a total of 250 CRC cases that underwent surgical resection. CRCs included 63 well-to-moderately differentiated adenocarcinomas (WMDAs), 91 poorly differentiated adenocarcinomas (PDAs), 81 mucinous adenocarcinoma (MUAs), and 15 signet-ring cell carcinomas (SRCCs). MUC2 and MUC5AC were scored as positive when ≥ 25% and ≥ 1% of cancer cells were stained positive, respectively. The human mutL homolog 1 and human mutS homolog 2 expressions were assessed by immunohistochemistry in PDAs to investigate mismatch-repair (MMR) status. Tumors that did not express either of these two were considered MMR-deficient. Results were analyzed for associations with clinicopathologic variables and the prognosis in individual histological CRC subtypes. RESULTS: MUC2-positive and MUC5AC-positive WMDA percentages were 49.2% and 30.2%, respectively. In contrast, MUC2-positive and MUC5AC-positive PDA percentages were 9.5% and 51.6%, respectively. MUC2 levels tended to decrease and MUC5AC levels tended to increase from WMDA to PDA. In 21 tumors comprising both adenoma and adenocarcinoma components in a single tumor (4 WMDAs, 7 PDAs, and 10 MUAs), MUC2 was significantly downregulated in PDA and MUC5AC was downregulated in PDA and MUA in the adenoma-carcinoma sequence. These results suggested that MUC2 levels might be associated with malignant potential and that MUC5AC expression was an early event in tumorigenesis. Despite worse prognoses than WMDA, high MUC2 expression levels were maintained in MUA (95.1%) and SRCC (71.5%), which suggested a pathogenesis for these subtypes distinct from that of WMDA. No significant associations were found between MUC2 expression and any clinicopathologic variables in any histological subtype. MUC5AC expression in PDA was closely associated with right-sided location (P = 0.017), absence of nodal metastasis (P = 0.010), low tumor node metastasis stage (P = 0.010), and MMR deficiency (P = 0.003). MUC2 expression in WMDA was a marginal prognostic factor for recurrence/metastasis-free survival (RFS) by univariate Cox analysis (P = 0.077) but not by multivariate Cox analysis (P = 0.161). MUC5AC expression in PDA was a significant prognostic factor for RFS by univariate Cox analysis (P = 0.007) but not by multivariate Cox analysis (P = 0.104). Kaplan-Meier curves and log-rank tests revealed that MUC2 expression was marginally associated with a better WMDA prognosis [P = 0.064 for RFS and P = 0.172 for overall survival (OS)] but not for PDA. In contrast, MUC5AC expression was significantly and marginally associated with a better PDA prognosis in terms of RFS and OS, respectively (P = 0.004 for RFS and P = 0.100 for OS), but not for WMDA and MUA. CONCLUSION: Mucin core protein expression profiles and clinical significance differ according to histological CRC subtypes. This may reflect different pathogeneses for these tumors.
目的:研究黏蛋白(MUC)在结直肠癌(CRC)组织学亚型中的表达谱与临床病理变量和预后的关系。
方法:对 250 例接受手术切除的 CRC 病例进行 MUC2 和 MUC5AC 的免疫组织化学评估。CRC 包括 63 例中至高度分化腺癌(WMDAs)、91 例低分化腺癌(PDAs)、81 例黏液性腺癌(MUAs)和 15 例印戒细胞癌(SRCCs)。当≥25%和≥1%的癌细胞染色阳性时,分别将 MUC2 和 MUC5AC 评为阳性。在 PDAs 中通过免疫组织化学评估人 mutL 同源物 1 和人 mutS 同源物 2 的表达,以研究错配修复(MMR)状态。如果这两种表达都不表达,则认为是 MMR 缺陷。结果与各个组织学 CRC 亚型的临床病理变量和预后进行了分析。
结果:MUC2 阳性和 MUC5AC 阳性的 WMDA 百分比分别为 49.2%和 30.2%。相比之下,MUC2 阳性和 MUC5AC 阳性的 PDA 百分比分别为 9.5%和 51.6%。从 WMDAs 到 PDAs,MUC2 水平趋于降低,而 MUC5AC 水平趋于增加。在 21 个包含单个肿瘤中腺瘤和腺癌成分的肿瘤(4 个 WMDAs、7 个 PDAs 和 10 个 MUAs)中,PDA 中 MUC2 显著下调,而在腺瘤-癌序列中 PDA 和 MUA 中 MUC5AC 下调。这些结果表明,MUC2 水平可能与恶性潜能有关,而 MUC5AC 表达是肿瘤发生的早期事件。尽管预后比 WMDAs 差,但 MUA(95.1%)和 SRCC(71.5%)中仍保持高 MUC2 表达水平,这表明这些亚型的发病机制与 WMDAs 不同。在任何组织学亚型中,MUC2 表达与任何临床病理变量之间均无显著关联。PDA 中 MUC5AC 的表达与右侧位置(P=0.017)、无淋巴结转移(P=0.010)、低肿瘤淋巴结转移分期(P=0.010)和 MMR 缺陷(P=0.003)密切相关。WMDA 中 MUC2 表达是无复发生存(RFS)的单因素 Cox 分析的边缘预后因素(P=0.077),但不是多因素 Cox 分析的预后因素(P=0.161)。PDA 中 MUC5AC 的表达是 RFS 的单因素 Cox 分析的显著预后因素(P=0.007),但不是多因素 Cox 分析的预后因素(P=0.104)。Kaplan-Meier 曲线和对数秩检验表明,MUC2 表达与 WMDA 的更好预后(RFS:P=0.064;OS:P=0.172)相关,但与 PDA 无关。相比之下,MUC5AC 表达与 PDA 的 RFS 和 OS 预后显著相关(RFS:P=0.004;OS:P=0.100),但与 WMDA 和 MUA 无关。
结论:黏蛋白核心蛋白的表达谱和临床意义因结直肠癌组织学亚型而异。这可能反映了这些肿瘤的不同发病机制。
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