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目的初步研究进展期胃癌的多层CT增强征象与肿瘤组织分化及p53、P-糖蛋白(P-gp)表达的关系。资料与方法手术切除且资料完整的胃癌患者66例。所有病例术前均行上腹部多层CT常规及双期增强检查,观察内容包括肿瘤部位、最大直径、胃壁浸润厚度、双期强化率、淋巴结转移等。术后标本经10%甲醛固定、石蜡包埋、组织切片,采用常规HE染色确定组织分化和免疫组织化学检测p53、P-gp在胃癌中表达。比较胃癌的多层CT增强征象与组织分化及p53、P-gp在胃癌表达间的关系。结果73.1%(19/26)均匀强化的胃癌为高/中分化腺癌,75%(30/40)分层强化或不均匀强化的胃癌为低分化腺癌,两者比较差异有统计学意义(P=0.000)。CT双期增强的强化率与胃癌组织分化无关(P>0.05);p53、P-gp在分层强化或不均匀强化的胃癌中阳性表达率显著高于在均匀强化的胃癌中阳性表达(P<0.05)。p53阳性表达还与动脉期强化率、肿瘤大小和淋巴结转移有关(P<0.05),与胃壁浸润厚度、门静脉期强化率无关(P>0.05);而P-gp表达与门静脉期强化率有关(P=0.005),与动脉期强化率、胃壁浸润厚度、肿瘤大小和淋巴结转移无关(P>0.05)。结论胃癌不同的强化方式和双期强化率反映了胃癌的不同组织分化和p53、P-gp阳性表达,提示胃癌的多层CT增强征象与其组织分化及p53、P-gp表达有较密切的相关性。
Objective To study the relationship between multi-slice CT enhancement and the differentiation of tumor tissues and the expression of p53 and P-glycoprotein (P-gp) in advanced gastric cancer. Materials and Methods Surgical resection and complete data of 66 patients with gastric cancer. All patients underwent preoperative abdominal multi-slice CT routine and double-phase enhanced examination, the observation includes the tumor site, the maximum diameter, gastric wall thickness, double-stage rate of enhancement, lymph node metastasis. The specimens were fixed with 10% formaldehyde, embedded in paraffin and sliced. The expression of p53 and P-gp in gastric cancer was detected by routine HE staining and immunohistochemical staining. To compare the multi-slice computed tomography (CT) enhancement sign of gastric cancer with the tissue differentiation and the relationship between the expression of p53 and P-gp in gastric cancer. Results 73.1% (19/26) of well-differentiated gastric adenocarcinoma were hyper-differentiated adenocarcinoma, and 75% (30/40) of stratified or non-uniformly differentiated gastric carcinoma were poorly differentiated adenocarcinoma with statistically significant difference (P = 0.000). The enhanced rate of double enhancement in CT was not related to the differentiation of gastric cancer (P> 0.05). The positive expression rate of p53 and P-gp in gastric cancer with stratified enhancement or non-uniformity was significantly higher than that in homogeneous enhancement gastric cancer (P <0.05). The positive expression of p53 was also related to the rate of arterial phase enhancement, tumor size and lymph node metastasis (P <0.05), but not to the gastric wall thickness and portal venous enhancement rate (P> 0.05), while the expression of P-gp was related to portal venous enhancement rate P = 0.005), and had no relation with the enhancement rate of arterial phase, the thickness of gastric wall infiltration, tumor size and lymph node metastasis (P> 0.05). Conclusion The different enhancement methods and double enhancement rates of gastric cancer reflect the different tissue differentiation and the positive expression of p53 and P-gp in gastric cancer, suggesting that the multi-slice CT enhancement signs of gastric cancer are closely related to the histological differentiation and the expression of p53 and P-gp Sex.