肝癌衍生生长因子和细胞外基质蛋白－1对原发性肝内胆管细胞癌的鉴别诊断和预后意义

摘要

目的：研究肝癌衍生生长因子（HDGF）和细胞外基质蛋白－1（ECM1）对原发性肝内胆管细胞癌（PICC）和结直肠癌（CRC）的鉴别诊断价值。方法：对55例 PICC、60例肝脏转移性 CRC 以及60例原发性CRC 标本行免疫组织化学（IHC）染色和统计学处理。结果：32例（58．2％）PICC 归为肿块型，13例（23．6％）为导管内乳头状型，10例（18．2％）为周围导管浸润型。PICC 中 ECM1表达与男性（P ＝0．033）、肝门区（P ＝0．027）、导管内乳头黏液腺瘤（P ＝0．000）和肠型上皮细胞（P ＜0．001）显著相关。HDGF ＋／ECM1－免疫表型诊断 PICC 有100％的阳性预测值（PPV）。HDGF －／ECM1＋免疫表型诊断转移性 CRC 有84．2％的 PPV 值。HDGF ＋／ECM1＋免疫表型诊断 PICC 和转移性 CRC 分别有86．7％和13．3％的 PPV 值。单变量 Cox 生存分析55例 PICC 标本，确认浸润深度（P ＝0．005）、淋巴结转移（P ＝0．012）、肿瘤阶段（P ＝0．004）以及血管浸润（P＝0．023）与病人不良预后显著相关。多变量 Cox 生存分析认为：肿瘤阶段（P ＝0．002）与病人生存期差有关。结论：PICC 中的 ECM1表达与性别、肿瘤位置、导管内乳头状生长型及肠表型呈统计学相关。HDGF 和 ECM1联合可作为鉴别 PICC 和转移性 CRC 的有用指标。%Objective:To analyzd differential diagnosis of hepatoma -derived growth factor(HDGF)and extracel-lular matrix protein 1(ECM1)to primary intrahepatic cholangiocarcinoma(PICC)and colorectal carcinoma(CRC). Methods:A total of 55 cases of PICC operation specimens,60 cases of metastatic CRC and 60 cases of primary CRC were tested by immunohistochemistry(IHC)staining and statistical processing.Results:32 cases(58.2%)PICC were mass type,13 cases(23.6%)were intraductal papillary type,10 cases(18.2%)were periductal infiltrative type.ECM1 expression in PICC was significantly related with male(P =0.033),hilar location(P =0.027),intraduc-tal papillary(P =0.000)and intestinal epithelial type(P <0.001).HDGF +/ECM1 -immune phenotype had 100%positive predictive value(PPV)in diagnosing PICC.HDGF -/ECM1 + immune phenotype had 84.2% PPV in diagno-sing metastatic CRC.HDGF +/ECM1 + immune phenotype had 86.7% and 13.3% PPV in differential diagnosing PICC and metastaticrespectively.Single variable Cox survival analysised 5 5 PICC confirmed infiltration depth (P=0.005),lymph node metastasis(P =0.012),tumor stage(P =0.004)and vascular invasion(P =0.023)were sig-nificantly related with patients'bad prognosis.Through multivariate Cox survival analysis:tumor stage(P =0.002)be-ing associated with poor survival.Conclusion:ECM1 expression in PICC was related with gender,tumor location,in-traductal papillary growth type and intestinal phenotype.Combined HDGF with ECM1 can be used as useful index for differential diagnosis of PICC and metastatic CRC.