Cavalcanti Elisabetta, De Michele Francesco, Lantone Giulio, Panarese Alba, Caruso Maria Lucia
Histopathology Unit, National Institute of Gastroenterology "S. de Bellis," Research Hospital, Castellana Grotte, Bari, Italy.
Surgery Unit, National Institute of Gastroenterology "S. de Bellis", Research Hospital, Castellana Grotte, Bari, Italy.
Cancer Manag Res. 2019 Jun 17;11:5047-5054. doi: 10.2147/CMAR.S193994. eCollection 2019.
Endoscopic submucosal dissection is widely employed in early gastric cancer (EGC). Foveolar phenotypes should be distinguished from the other differentiated EGC (DEGC) types because of their increased malignant potential. The phenotypic classification could be useful not only for investigating EGC tumorigenesis but also for evaluating the tumor aggressiveness to guide treatment decision making. On surgical tissue specimens, we studied the mucin phenotype of EGC to distinguish cases with a worse prognosis dictating different therapeutic options or a very close surveillance program. DEGC in our series were classified as mucin foveolar (51%) or mucin intestinal (49%) phenotype. We evaluated correlations among foveolar and intestinal phenotypic markers, tumor patterns, clinicopathologic features and prognostic and therapeutic implications. Immunohistochemistry (IHC) for MUC5AC and CDX2 was performed on 63 EGC patient specimens. MUCA5C was employed as gastric foveolar phenotypic marker and CDX2 as intestinal phenotypic marker. Foveolar DEGC was significantly associated with larger tumor size (=0.01), high grade (G2-G3) (=0.001), vessel permeation (=0.05), lymph node metastasis (=0.001) and ulceration (=0.001), whereas intestinal type DEGC was associated with low grade (=0.001). IHC determination of the mucin phenotype is an easy, inexpensive method that can provide useful, sensitive markers distinguishing the foveolar or intestinal phenotype in DEGC. The precise identification of the foveolar type, featuring a poorer prognosis, should sound a warning bell mandating very close study of the lesion before endoscopic treatment or contraindicating endoscopic resection in favor of the open surgery option.
内镜黏膜下剥离术在早期胃癌（EGC）中被广泛应用。由于胃小凹表型的恶性潜能增加，应将其与其他分化型早期胃癌（DEGC）类型区分开来。这种表型分类不仅有助于研究EGC的肿瘤发生机制，还能评估肿瘤的侵袭性，从而指导治疗决策。在手术组织标本上，我们研究了EGC的黏蛋白表型，以区分预后较差、需要不同治疗方案或密切监测的病例。我们系列中的DEGC分为胃小凹黏蛋白型（51%）或肠黏蛋白型（49%）。我们评估了胃小凹和肠表型标志物、肿瘤形态、临床病理特征以及预后和治疗意义之间的相关性。对63例EGC患者的标本进行了MUC5AC和CDX2的免疫组织化学（IHC）检测。MUCA5C用作胃小凹表型标志物，CDX2用作肠表型标志物。胃小凹型DEGC与较大的肿瘤大小（=0.01）、高级别（G2 - G3）（=0.001）、血管侵犯（=0.05）、淋巴结转移（=0.001）和溃疡（=0.001）显著相关，而肠型DEGC与低级别（=0.001）相关。通过IHC测定黏蛋白表型是一种简单、廉价的方法，能够提供有用且敏感的标志物，区分DEGC中的胃小凹或肠表型。胃小凹型预后较差，准确识别该类型应敲响警钟，在内镜治疗前需对病变进行密切研究，或不建议内镜切除而选择开放手术。
