Zhang Kun-Ning, Jin Mu-Lan, Zhai Zhi-Wei
Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
Department of General Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
World J Gastrointest Surg. 2025 Jun 27;17(6):104505. doi: 10.4240/wjgs.v17.i6.104505.
BACKGROUND: Self-expandable metallic stent (SEMS) placement is a common intervention for obstructive left-sided colon cancer. However, the long-term prognosis post-SEMS placement remains debated. Mechanical compression within the tumor caused by SEMS may induce vascular compression, leading to tissue ischemia and hypoxia. These alterations in the tumor microenvironment could affect patient prognosis. AIM: To assess the influence of glucose transporter-1 (GLUT-1) and Ki-67 expression in obstructive colon cancer tissues pre and post SEMS placement on patient prognosis. METHODS: A retrospective analysis was conducted on clinical and pathological data from 71 patients with obstructive colon cancer who underwent SEMS placement followed by surgery. Paired colon cancer tissue samples were collected from each patient pre and post SEMS placement. Immunohistochemical techniques were employed to evaluate GLUT-1 and Ki-67 expression in the specimens. RESULTS: The high expression rates of GLUT-1 in the samples obtained before and after SEMS placement were 14.1% and 43.7%, respectively ( < 0.001). GLUT-1 expression was associated with vascular invasion post-SEMS placement ( = 0.03). Ki-67 expression showed no significant difference pre and post SEMS placement and was unrelated to clinical pathological characteristics (all > 0.05). The high expression rates of GLUT-1 in the samples obtained before and after SEMS placement were associated with worse recurrence-free interval (pre-SEMS: 40.0% 72.3%, = 0.026; post-SEMS: 45.5% 85.7%, = 0.001). Cox regression analysis revealed that both pre-SEMS placement (HR = 3.490, 95%CI: 1.165-10.453, = 0.026) and post-SEMS placement (HR = 4.335, 95%CI: 1.539-12.214, = 0.006) GLUT-1 expression were adverse prognostic factors for patients. CONCLUSION: Though the precise impact of stent placement on the mechanical compression and biological behavior of tumors is not fully understood, our study found an increase in GLUT-1 expression in tumor tissues after SEMS placement. Tumor GLUT-1 serves as a prognostic biomarker for the survival of patients with obstructive colon cancer treated with SEMS placement.
背景：自膨式金属支架（SEMS）置入是梗阻性左侧结肠癌的常见干预措施。然而，SEMS置入后的长期预后仍存在争议。SEMS导致的肿瘤内部机械压迫可能会引起血管受压，导致组织缺血和缺氧。肿瘤微环境的这些改变可能会影响患者预后。 目的：评估SEMS置入前后梗阻性结肠癌组织中葡萄糖转运蛋白-1（GLUT-1）和Ki-67表达对患者预后的影响。 方法：对71例行SEMS置入后接受手术的梗阻性结肠癌患者的临床和病理数据进行回顾性分析。从每位患者SEMS置入前后采集配对的结肠癌组织样本。采用免疫组织化学技术评估标本中GLUT-1和Ki-67的表达。 结果：SEMS置入前后样本中GLUT-1的高表达率分别为14.1%和43.7%（<0.001）。GLUT-1表达与SEMS置入后血管侵犯相关（=0.03）。Ki-67表达在SEMS置入前后无显著差异，且与临床病理特征无关（均>0.05）。SEMS置入前后样本中GLUT-1的高表达率与无复发生存期较差相关（SEMS置入前：40.0%对72.3%，=0.026；SEMS置入后：45.5%对85.7%，=0.001）。Cox回归分析显示，SEMS置入前（HR=3.490，95%CI：1.165-10.453，=0.026）和SEMS置入后（HR=4.335，95%CI：1.539-12.214，=0.006）GLUT-1表达均为患者不良预后因素。 结论：尽管支架置入对肿瘤机械压迫和生物学行为的确切影响尚未完全了解，但我们的研究发现SEMS置入后肿瘤组织中GLUT-1表达增加。肿瘤GLUT-1可作为接受SEMS置入治疗的梗阻性结肠癌患者生存的预后生物标志物。
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