Lagorce-Pages C, Paraf F, Dubois S, Belghiti J, Fléjou J F
Department of Pathology, hôpital Beaujon, Clichy, France.
Histopathology. 1998 Jan;32(1):7-14. doi: 10.1046/j.1365-2559.1998.00316.x.
To establish the prevalence of CD44 protein expression in a large surgical series of Barrett's adenocarcinoma and associated preneoplastic lesions and to correlate this expression with clinicopathological data and prognosis.
CD44H and variants (V4/V5, V6) expression was detected by immunohistochemistry in formalin-fixed, paraffin wax tissue samples of Barrett's mucosa (50) and Barrett's adenocarcinoma (73) obtained from surgical resections from 73 patients. This expression was correlated with pathological features of the tumour and prognosis. CD44H and V6 expression was found in 62% and 55% of Barrett's specialized mucosa negative for dysplasia and in 70% and 63% of Barrett's adenocarcinoma, respectively. CD44H and V6 expression was restricted to the lower part of the crypts in Barrett's specialized mucosa negative for dysplasia and reached the upper part of the crypts in high-grade dysplasia. A significant relation was found between CD44V6 expression and depth of tumour invasion in the oesophageal wall (P = 0.05), neoplastic vascular invasion (P = 0.0001), neoplastic perineural invasion (P = 0.0004) and stage in Rosenberg's classification (P = 0.02). Cancers with CD44V6 expression had a significantly poorer prognosis (5-year survival: 17%) than those without (5-year survival: 44%) (P = 0.02) in univariate analysis. However, multivariate analysis showed that CD44V6 expression had no independent prognostic value when tumour invasion and lymph node involvement were taken as explanatory variables.
CD44H and V6 are frequently expressed in Barrett's oesophagus. The pattern of expression that we observed from mucosa negative for dysplasia to adenocarcinoma suggests that CD44H and V6 may be involved in the carcinogenesis of Barrett's mucosa. CD44V6 expression in adenocarcinoma is correlated to aggressive pathological features.
在大量手术切除的巴雷特腺癌及相关癌前病变病例中确定CD44蛋白表达的发生率，并将该表达与临床病理数据及预后相关联。
通过免疫组织化学检测了73例患者手术切除获得的福尔马林固定、石蜡包埋组织样本中巴雷特黏膜（50例）和巴雷特腺癌（73例）中CD44H及变体（V4/V5、V6）的表达。该表达与肿瘤的病理特征及预后相关。在无异型增生的巴雷特特殊黏膜中，分别有62%和55%检测到CD44H和V6表达，在巴雷特腺癌中分别为70%和63%。在无异型增生的巴雷特特殊黏膜中，CD44H和V6表达局限于隐窝下部，在高级别异型增生中则到达隐窝上部。发现CD44V6表达与肿瘤侵犯食管壁的深度（P = 0.05）、肿瘤血管侵犯（P = 0.0001）、肿瘤神经周围侵犯（P = 0.0004）及罗森伯格分类中的分期（P = 0.02）之间存在显著关联。单因素分析显示，有CD44V6表达的癌症预后明显较差（5年生存率：17%），而无该表达的癌症（5年生存率：44%）（P = 0.02）。然而，多因素分析表明，当以肿瘤侵犯和淋巴结受累作为解释变量时，CD44V6表达无独立预后价值。
CD44H和V6在巴雷特食管中经常表达。我们观察到的从无异型增生的黏膜到腺癌的表达模式表明，CD44H和V6可能参与了巴雷特黏膜的致癌过程。腺癌中CD44V6表达与侵袭性病理特征相关。
