Zhou Zhi-Yi, Sun Jie, Guo Qing, Zhao Hai-Bin, Zhou Zhi-Hua
Department of Pathology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, China.
Center of Clinical Research, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, China.
Diagn Pathol. 2021 Jul 31;16(1):66. doi: 10.1186/s13000-021-01128-w.
Certain gastric cancers exhibit some primitive phenotypes, which may indicate a high malignancy. In histologically differentiated early gastric cancer (EGC), the presence and the clinicopathological significance of the primitive phenotype remain unclear.
Using immunohistochemical staining we detected the expression of three primitive phenotypic markers SALL4, Glypican-3(GPC3), and AFP in whole tissue sections of differentiated EGC (gastrectomy specimens, n = 302). For those cases with primitive phenotypes, we analyzed their clinicopathological features and evaluated whether the criteria for endoscopic resection were met.
We found that 9.3% (28/302) of all differentiated EGC cases have primitive phenotypes, and most of these cases (25/28) exhibit a histomorphology similar to conventional differentiated EGC. Patients with primitive phenotypes had a deeper invasion, a higher rate of ulcer and lymphatic invasion than cases without primitive phenotype. Moreover, patients with primitive phenotypes displayed a significantly higher frequency of LNM than those without (57.1% vs 8.8%, P < 0.001). Multivariate analysis revealed that presence of primitive phenotypes was an independent risk factor for LNM (P = 0.001, HR 6.977, 95% CI: 2.199-22.138). Interestingly, we found 2 cases with primitive phenotypes developed LNM, and they both met the expanded indications of endoscopic resection for differentiated EGC.
A small number of differentiated EGC have primitive phenotypes, which were closely related to LNM and were an independent risk factor for LNM. Given its highly aggressive behavior, differentiated EGC with primitive phenotypes should be evaluated with stricter criteria before endoscopic resection, or considered to give an additional surgical operation after endoscopic resection.
某些胃癌表现出一些原始表型，这可能表明其具有高恶性程度。在组织学分化型早期胃癌（EGC）中，原始表型的存在及其临床病理意义仍不清楚。
我们采用免疫组织化学染色法，检测了分化型EGC全组织切片（胃切除标本，n = 302）中三种原始表型标志物SALL4、磷脂酰肌醇蛋白聚糖-3（GPC3）和甲胎蛋白（AFP）的表达。对于那些具有原始表型的病例，我们分析了其临床病理特征，并评估是否符合内镜切除标准。
我们发现，所有分化型EGC病例中有9.3%（28/302）具有原始表型，且这些病例中的大多数（25/28）表现出与传统分化型EGC相似的组织形态学。具有原始表型的患者比无原始表型的患者浸润更深，溃疡和淋巴侵犯发生率更高。此外，具有原始表型的患者发生淋巴结转移（LNM）的频率显著高于无原始表型的患者（57.1%对8.8%，P < 0.001）。多因素分析显示，原始表型的存在是LNM的独立危险因素（P = 0.001，风险比6.977，95%置信区间：2.199 - 22.138）。有趣的是，我们发现2例具有原始表型的病例发生了LNM，且它们均符合分化型EGC内镜切除的扩大指征。
少数分化型EGC具有原始表型，这与LNM密切相关，是LNM的独立危险因素。鉴于其高度侵袭性的行为，对于具有原始表型的分化型EGC，在内镜切除前应采用更严格的标准进行评估，或考虑在内镜切除后追加手术。
