本文選題：食管胃結(jié)合部腺癌 + 臨床病理分析��； 參考：《首都醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討Siewert II型和III型食管胃結(jié)合部腺癌淋巴結(jié)轉(zhuǎn)移特點及其臨床意義。方法:對2014年8月至2016年8月期間進行食管胃結(jié)合部腺癌根治切除術(shù)加淋巴結(jié)清掃術(shù)的67例患者,將其手術(shù)切除標本進行取材,由病理學(xué)家和臨床醫(yī)生共同收集淋巴結(jié),進行細致的分組,逐枚進行病理組織學(xué)和免疫組織化學(xué)檢查,判斷淋巴結(jié)是否轉(zhuǎn)移并計算淋巴結(jié)轉(zhuǎn)移率和淋巴結(jié)轉(zhuǎn)移度。分析淋巴結(jié)轉(zhuǎn)移率和淋巴結(jié)轉(zhuǎn)移度與腫瘤大小、TNM分期(Tumor Node Metastasis,TNM)、Borrmann分型、腫瘤分型等方面的關(guān)系。結(jié)果:67例食管胃結(jié)合部腺癌患者中,Siewert II型有49例,淋巴結(jié)轉(zhuǎn)移陽性31例(63.3%),共收獲961枚淋巴結(jié),平均每例19.6枚;Siewert III型有18例,淋巴結(jié)轉(zhuǎn)移陽性11例(61.1%),Siewert III型共收獲512枚淋巴結(jié),平均每例28.4枚。腫瘤直徑與淋巴結(jié)轉(zhuǎn)移率的關(guān)系差異無統(tǒng)計學(xué)意義(P0.05),但腫瘤直徑與淋巴結(jié)轉(zhuǎn)移度的關(guān)系差異有統(tǒng)計學(xué)意義(P0.001)。TNM分期中,淋巴結(jié)轉(zhuǎn)移率隨著腫瘤分期的增加而增加,IIIB和IIIC期患者淋巴結(jié)轉(zhuǎn)移率均為100%,其轉(zhuǎn)移度在31.46%~39.94%之間,較I、II期者高(P0.001)。Borrmann分型中,III型病例的淋巴結(jié)轉(zhuǎn)移率(75.00%)較其他型患者高(P0.05)。在淋巴結(jié)轉(zhuǎn)移率上,Siewert II型淋巴結(jié)轉(zhuǎn)移率由高到低依次為第3、1、2、7=11、4=8,9=5=110組,以3組轉(zhuǎn)移率為最高(46.94%);Siewert III型淋巴結(jié)轉(zhuǎn)移率由高到低依次為第3、1=2、7=11、9=6、4=8=5組,其中最高轉(zhuǎn)移率為第3組(55.56%);食管胃結(jié)合部腺癌各分型與淋巴結(jié)轉(zhuǎn)移率的關(guān)系差異無統(tǒng)計學(xué)意義(P0.05)。在淋巴結(jié)轉(zhuǎn)移度上,Siewert II型中,淋巴結(jié)轉(zhuǎn)移度由高到低依次是,第2、1、110、3、11、5、7、4、8、9組,其中轉(zhuǎn)移度最高的是2組(48.72%)。Siewert III型中,淋巴結(jié)轉(zhuǎn)移度由高到低依次是,第2、3、11、7、6、5、1、9、8、4組,其中轉(zhuǎn)移度最高的是2組(80.95%);在淋巴結(jié)轉(zhuǎn)移度中Siewert II型和III型在第1組(p=0.001),2組(p=0.015),6組(p=0.03)中,存在統(tǒng)計學(xué)差異。結(jié)論:Siewert II型和III型食管胃結(jié)合部腺癌臨床病理特征顯著不同;不同分型的食管胃結(jié)合部腺癌的淋巴結(jié)轉(zhuǎn)移率無統(tǒng)計學(xué)差異,這可能與病例數(shù)偏少有關(guān),在本組研究中,與Siewert III型腫瘤相比,II型腫瘤更易出現(xiàn)食管旁的淋巴結(jié)(第110組)轉(zhuǎn)移。在淋巴結(jié)轉(zhuǎn)移度方面,Siewert II型腫瘤更易出現(xiàn)賁門右淋巴結(jié)(第1組)(P0.05),而Siewert III型腫瘤更易出現(xiàn)賁門左淋巴結(jié)(第2組)(P0.05)淋巴結(jié)轉(zhuǎn)移,二者存在明顯的統(tǒng)計學(xué)差異。因此,Siewert II型腫瘤有必要清掃110組、1組,Siewert III型腫瘤有必要清掃第2組淋巴結(jié)。目的:探究Siewert II食管胃結(jié)合部腺癌組織中PDZK1和PDGFR-β的表達以及相互之間的作用,對比PDZK1和PDGFR-β在Siewert II型食管胃結(jié)合部腺癌與遠端胃癌的表達差異。方法:從患者組織蠟塊中采集標本,制作成石蠟切片,進行免疫組織化學(xué)染色。采用半定量評分系統(tǒng)評定免疫組織化學(xué)染色結(jié)果并做統(tǒng)計分析。結(jié)果:PDZK1在食管胃結(jié)合部腺癌組織中陽性表達率為30%(12/40),在食管胃結(jié)合部正常組織中陽性表達率為95%(38/40),差異有統(tǒng)計學(xué)意義(χ2=36.053,P0.001)。PDGFR-β在食管胃結(jié)合部腺癌組織中陽性表達率為80%(32/40),食管胃結(jié)合部正常組織中陽性表達率為28%(11/40),差異有統(tǒng)計學(xué)意義(χ2=22.175,P0.001)。PDZK1和PDGFR-β在食管胃結(jié)合部正常組織無明顯相關(guān)性(r=0.026,P=0.874),PDZK1和PDGFR-β在食管胃結(jié)合部腺癌組織無明顯相關(guān)性(r=0.111,P=0.497)。對比遠端胃癌,結(jié)果發(fā)現(xiàn)PDZK1在胃食管結(jié)合部正常組織中表達要高于遠端胃正常組織(Ζ=-1.997,P=0.046),同樣PDGFR-β在胃食管結(jié)合部腺癌組織中表達要高于遠端胃癌組織(Ζ=-3.811,P=0.000),差異具有統(tǒng)計學(xué)意義。結(jié)論:PDGFR-β在Siewert II食管胃結(jié)合部腺癌組織中呈現(xiàn)高表達,PDZK1在Siewert II食管胃結(jié)合部正常組織中呈現(xiàn)高表達。PDZK1與PDGFR-β在Siewert II食管胃結(jié)合部腺癌組織和正常組織中的表達均未表現(xiàn)出相關(guān)性。Siewert II型食管胃結(jié)合部腺癌中PDZK1與PDGFR-β的表達要高于遠端胃癌,結(jié)合其臨床特點,食管胃結(jié)合部腺癌可能是不同于遠端胃癌的一類特殊腫瘤,而且PDZK1有可能在AEG的分子分型和靶向治療方面提供一定的參考價值。
[Abstract]:Objective: To investigate the characteristics and clinical significance of lymph node metastasis of Siewert II and III type esophagogastric junction adenocarcinoma. Methods: 67 patients with adenocarcinoma resection of the esophagogastric junction and lymph node dissection were performed from August 2014 to August 2016, and the specimens were removed and collected by the pathologists and clinicians. Lymph node metastasis rate and lymph node metastasis rate and tumor size, TNM staging (Tumor Node Metastasis, TNM), Borrmann classification, tumor typing, etc. were analyzed for lymph node metastasis and lymph node metastasis. Results: among the 67 cases of adenocarcinoma of the esophagogastric junction, there were 49 cases of Siewert II and 31 cases of lymph node metastasis (63.3%), and 961 lymph nodes were harvested, with an average of 19.6 nodes, 18 cases of Siewert III, 11 cases of lymph node metastasis (61.1%), and 512 lymph nodes of Siewert III, the average of 28.4. Tumor diameter and lymph nodes There was no statistical significance (P0.05), but the difference in the relationship between tumor diameter and lymph node metastasis was statistically significant (P0.001) in.TNM staging, the lymph node metastasis rate increased with the increase of tumor staging. The lymph node metastasis rate in IIIB and IIIC patients was 100%, and the metastatic degree was between 31.46%~39.94%, higher than that of I and II stage. (P0.001).Borrmann typing, the lymph node metastasis rate of III type cases (75%) was higher than that of other type patients (P0.05). In the lymph node metastasis rate, the Siewert II lymph node metastasis rate from high to low was in group 3,1,2,7=11,4=8,9=5=110, with the highest transfer rate in the 3 group (46.94%); Siewert III type lymph node metastasis rate was in the order of 3,1=2 in the order of high to low. In group 7=11,9=6,4=8=5, the highest metastasis rate was in third groups (55.56%), and there was no significant difference in the relationship between the types of adenocarcinoma of the esophagogastric junction and the lymph node metastasis rate (P0.05). In the lymph node metastasis degree, the lymph node metastasis degree from high to low was in the order of 2,1110,3,11,5,7,4,8,9, and the highest degree of metastasis was in the 2 group (48.). 72%) in.Siewert III, lymph node metastasis was from high to low, in group 2,3,11,7,6,5,1,9,8,4, among which the highest metastasis was in group 2 (80.95%). In lymph node metastasis, Siewert II and III were in group first (p=0.001), 2 group (p=0.015), and 6 group (p=0.03). Conclusion: Siewert II type and III type esophagogastric junction gland The clinicopathological features of cancer were significantly different; there was no statistical difference in the lymph node metastasis rate of the adenocarcinoma of the esophagogastric junction with different types. This may be associated with fewer cases. In this study, II type tumors were more susceptible to the metastasis of the lymph nodes beside the esophagus (110th groups) than the type Siewert III tumor. In the lymph node metastasis, the Siewert II type The tumor is more likely to appear in the cardiac right lymph node (first groups) (P0.05), while the Siewert III type tumor is more likely to appear in the cardiac left lymph node (second groups) (P0.05) lymph node metastasis, and there is a significant statistical difference between the two groups. Therefore, the Siewert II tumor is necessary to clean up 110 groups, 1 groups, Siewert III type tumor is necessary to clear the second groups of lymph nodes. Purpose: To explore Siewer The expression of PDZK1 and PDGFR- beta in the adenocarcinoma of the esophagogastric junction of t II and the interaction between them, and the difference in the expression of PDZK1 and PDGFR- beta in the adenocarcinoma of the esophagogastric junction and the distal gastric cancer of the Siewert II type. Methods: the specimens were collected from the paraffin block of the patients and made into paraffin sections to perform immunohistochemical staining. The positive rate of PDZK1 was 30% (12/40) in the adenocarcinoma of the esophagogastric junction, and the positive rate was 95% (38/40) in the normal tissues of the esophagogastric junction. The difference was statistically significant (x 2= 36.053, P0.001).PDGFR- beta in the adenocarcinoma of the esophagogastric junction, Zhongyang The positive rate of sexual expression was 80% (32/40), and the positive expression rate in the normal tissues of the esophagogastric junction was 28% (11/40). The difference was statistically significant (x 2=22.175, P0.001).PDZK1 and PDGFR- beta had no significant correlation (r=0.026, P=0.874) in the normal tissues of the esophagogastric junction (r=0.026, P=0.874). PDZK1 and PDGFR- beta had no significant correlation in the adenocarcinoma of the esophagogastric junction (r=0.111, P=0.49). 7. Compared to the distal gastric carcinoma, it was found that the expression of PDZK1 in the normal tissues of the gastroesophageal junction was higher than that of the distal gastric normal tissue (=-1.997, P=0.046), and the same expression of PDGFR- beta in the adenocarcinoma of the gastroesophageal junction was higher than that of the distal gastric carcinoma (=-3.811, P=0.000), and the difference was statistically significant. Conclusion: PDGFR- beta in the II esophagus of Siewert II esophagus stomach. The high expression of PDZK1 in normal tissues of Siewert II esophagogastric junction showed high expression of.PDZK1 and PDGFR- beta in the adenocarcinoma tissue and normal tissues of Siewert II esophagogastric junction. The expression of PDZK1 and PDGFR- beta in.Siewert II type esophagogastric junction was higher than that of the distal end. Combined with the clinical characteristics of gastric cancer, the adenocarcinoma of the esophagogastric junction may be a special type of tumor which is different from the distal gastric cancer, and PDZK1 may provide a certain reference value for the molecular typing and targeting therapy of AEG.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735

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本文編號：1993166