Expression and its clinical significance of gastric and intestinal phenotypic markers in 47 Siewert type II and type III early gastroesophageal junctional cancers
2017
Objective
To investigate the expression of gastric and intestinal phenotypic markers in Siewert typeⅡand Ⅲ early gastroesophageal junction(GEJ) cancer, and to explore its correlation with clinic-pathological features.
Methods
From April 2010 to July 2015, 53 cases diagnosed as early GEJ cancer were enrolled. The gastric and intestinal phenotypic markers such as mucin5AC(MUC5AC), mucin6(MUC6), mucin2(MUC2), caudal related homeodomain transcription 2(CDX2) and cluster of differentiation 10(CD10) were detected, and then the patients were divided into gastric type, gastrointestinal type, intestinal type and non-classified type according to the results of immunohistochemical staining. Combined with Siewert classification the clinicopathological features were analyzed. Chi square test or Fisher′s exact test was performed for statistical analysis.
Results
In the cancer tissues of 47 patients with Siewert type Ⅱand Ⅲ early GEJ cancer, the case numbers of positive expression of MUC5AC, MUC6, MUC2, CDX2 and CD10 were 21(44.7%), 19(40.4%), 31(66.0%), 27(57.4%) and 17(36.2%), respectively; the case numbers of gastric type, gastrointestinal type, intestinal type and non-classified type were 11(23.4%), 14(29.8%), 21(44.7%) and one(2.1%), respectively. The positive expression rates of MUC5AC and MUC6 in Siewert typeⅡwere 55.9%(19/34) and 50.0%(17/34), which were higher than those of Siewert typeⅢ(2/13), and the positive expression rate of MUC2 was 55.9%(19/34), which was lower than that of Siewert typeⅢ(12/13), and the differences were statistically significant (χ2=6.240, 4.679 and 4.053; all P<0.05). In Siewert typeⅡ, the proportion of intestinal type was 32.4%(11/34), which was lower than that of Siewert typeⅢ(10/13), and the differences were statistically significant (χ2=7.142, P=0.010). In patients with Siewert typeⅡand Ⅲ early cancer, males predominated in intestinal type which were mostly well differentiated type with less submucosal carcinoma. The maximum diameter of tumor was less than those of gastric type and gastrointestinal type. In paracancerous mucosal tissues, the incidences of intestinal metaplasia in gastrointestinal type and intestinal type were 11/14 and 81.0%(17/21), which were higher than that of gastric type (3/11); the incidences of atrophy in gastrointestinal type and intestinal type were 12/14 and 85.7%(18/21), which were higher than that of gastric type (4/11), and the differences were statistically significant (Fisher′s exact test, all P<0.05).
Conclusions
Siewert typeⅡand Ⅲ early GEJ cancer can directly originated not only from gastric mucosa, but also from gastrointestinal and intestinal mucosa. Atrophy and intestinal metaplasia could exist before cancer genesis.
Key words:
Early gastroesophageal junctional cancer; Siewert classification; Gastric and intestinal phenotypic markers
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