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目的探讨胃间质瘤(GSTs)组织中成纤维细胞活化蛋白(FAP)的表达情况及其与预后的相关性。方法收集2010年1月至2013年12月间我院病理科保存的GSTs石蜡标本,通过免疫组化染色检测FAP表达;另取GSTs高、低恶性度患者新鲜肿瘤组织,进行FAP蛋白芯片分析,分析FAP与肿瘤临床病理特点及患者预后间的关系。结果本研究共纳入98例符合标准的病例,通过免疫组化染色显示FAP表达于GSTs细胞的胞浆,阳性表达率为42.9%,在正常胃组织中不表达。在不同性别、年龄及核分裂象数的患者中,FAP表达差异无统计学意义(P均>0.05);而在不同肿瘤长径和危险度分级患者中,FAP表达差异有统计学意义(P均<0.05),长径较大和中高危险度分级的肿瘤,FAP阳性表达率更高。FAP蛋白芯片分析结果显示,高恶性度GSTs组织中FAP表达量较在低恶性度GSTs组织的表达上调8.4倍。FAP表达与常规免疫组化指标之间无明显关联性。生存分析示:核分裂象数、肿瘤长径、术后服用伊马替尼(IM)及FAP表达,影响中高危GSTs患者无复发累积生存率(RFS)(P均<0.05)。Cox多因素回归示:核分裂象数、肿瘤长径、术后服用IM及FAP表达,是影响中高危GSTs患者RFS的独立因素(P均<0.05)。结论 FAP表达于GSTs细胞的胞浆,而在正常胃组织中不表达。FAP可辅助评估中高危GSTs患者的预后。
Objective To investigate the expression of fibroblast activating protein (FAP) in gastric stromal tumors (GSTs) and its correlation with prognosis. Methods The paraffin specimens of GSTs preserved in our hospital from January 2010 to December 2013 were collected and the expression of FAP was detected by immunohistochemical staining. Fresh tumor tissues from patients with high and low grade GSTs were analyzed by FAP protein chip, To analyze the relationship between FAP and clinicopathological features and prognosis of patients. Results A total of 98 cases were included in this study. The expression of FAP in the cytoplasm of GSTs was detected by immunohistochemistry. The positive expression rate of FAP was 42.9%, which was not expressed in normal gastric tissues. There was no significant difference in FAP expression between patients with different genders, ages and mitotic figures (P> 0.05), but there were significant differences in FAP expression among patients with different tumor length and risk grade (P < <0.05). FAP-positive expression rate was higher in tumors with longer diameter and higher risk grade. FAP protein chip analysis showed that the expression of FAP in high-grade GSTs was 8.4 times higher than that in low-grade GSTs. There was no significant correlation between FAP expression and routine immunohistochemistry. Survival analysis showed that mitotic figures, long diameter of tumor, postoperative administration of imatinib and FAP had no effect on recurrence-free survival (RFS) in intermediate and high-risk GSTs patients (all P <0.05). Cox multivariate regression showed that the number of mitotic figures, the length of tumor, the expression of IM and FAP after surgery were the independent factors influencing the RFS in middle and high risk GSTs patients (all P <0.05). Conclusion FAP expression in the cytoplasm of GSTs cells, but not in normal gastric tissue. FAP may assist in assessing the prognosis of high-risk GSTs.