Lin Juan, Chen Zhu-Feng, Guo Guo-Dong, Chen Xin
Shengli Clinical Medical College, Fujian Medical University, Fuzhou 350001, Fujian Province, China.
Department of Pathology, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China.
World J Gastrointest Oncol. 2024 Mar 15;16(3):687-698. doi: 10.4251/wjgo.v16.i3.687.
The Alcian blue (AB) and periodic acid Schiff (PAS) stains are representative mucus markers in gastric signet ring cell carcinoma (SRCC). They are low-cost special staining methods used to detect acidic mucus and neutral mucus, respectively. However, the clinical importance of the special combined AB and PAS stain is unclear.
To investigate AB expression, PAS expression and the AB-to-PAS (A/P) ratio in gastric SRCC patients and to assess patient prognosis.
Paraffin-embedded sections from 83 patients with gastric SRCC were stained with AB and PAS, and signet ring cell positivity was assessed quantitatively. Immunohistochemical staining for Ki67, protein 53 (P53) and human epidermal growth factor receptor 2 (HER2) was performed simultaneously. The cancer-specific survival (CSS) rate was estimated Kaplan-Meier analysis. Cox proportional hazards models were used for univariate and multivariate survival analyses.
Kaplan-Meier survival analysis revealed that the 3-year CSS rate was significantly greater in the high-PAS-expression subgroup than in the low-PAS-expression subgroup ( < 0.001). The 3-year CSS rate in the A/P ≤ 0.5 group was significantly greater than that in the A/P > 0.5 group ( = 0.042). Univariate Cox regression analysis revealed that the factors affecting prognosis included tumor diameter, lymph node metastasis, vessel carcinoma embolus, tumor stage, the A/P ratio and the expression of Ki67, P53 and the PAS. Cox multivariate regression analysis confirmed that low PAS expression [hazard ratio (HR) = 3.809, 95% confidence interval (CI): 1.563-9.283, = 0.003] and large tumor diameter (HR = 2.761, 95%CI: 1.086-7.020, = 0.033) were independent risk factors for poor prognosis.
A/P > 0.5 is potentially a risk factor for prognosis, and low PAS expression is an independent risk factor in the prognosis of gastric SRCC. PAS expression and the A/P ratio could help in predicting the clinical prognosis of patients with SRCC.
阿尔辛蓝（AB）染色和过碘酸希夫（PAS）染色是胃印戒细胞癌（SRCC）中具有代表性的黏液标记物。它们是分别用于检测酸性黏液和中性黏液的低成本特殊染色方法。然而，AB和PAS联合特殊染色的临床重要性尚不清楚。
研究胃SRCC患者的AB表达、PAS表达及AB与PAS之比（A/P），并评估患者预后。
对83例胃SRCC患者的石蜡包埋切片进行AB和PAS染色，并对印戒细胞阳性情况进行定量评估。同时进行Ki67、蛋白53（P53）和人表皮生长因子受体2（HER2）的免疫组化染色。采用Kaplan-Meier分析估计癌症特异性生存率（CSS）。Cox比例风险模型用于单因素和多因素生存分析。
Kaplan-Meier生存分析显示，高PAS表达亚组的3年CSS率显著高于低PAS表达亚组（<0.001）。A/P≤0.5组的3年CSS率显著高于A/P>0.5组（=0.042）。单因素Cox回归分析显示，影响预后的因素包括肿瘤直径、淋巴结转移、血管癌栓、肿瘤分期、A/P比值以及Ki67、P53和PAS的表达。Cox多因素回归分析证实，低PAS表达[风险比（HR）=3.809，95%置信区间（CI）：1.563-9.283，=0.003]和肿瘤直径较大（HR=2.761，95%CI：1.086-7.020，=0.033）是预后不良的独立危险因素。
A/P>0.5可能是预后的危险因素，低PAS表达是胃SRCC预后的独立危险因素。PAS表达和A/P比值有助于预测SRCC患者的临床预后。
