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目的探讨食管癌伴神经内分泌分化(E-NED)的临床病理特点及诊断标志物。方法回顾性分析2008年1月至2013年12月经病理证实的低分化食管癌378例患者的临床病理资料,其中无NED(E-NNED)349例,E-NED 29例,免疫组织化学检测29例E-NED以及随机选取20例E-NNED患者肿瘤组织中突触素(Syn)、嗜铬蛋白A(Cg A)、神经元特异性烯醇化酶(NSE)、神经细胞黏附分子(CD56)、蛋白基因产物9.5(PGP9.5)、促泌素(SCGN)、甲状腺转录因子1(TTF-1)的表达。结果 E-NED与E-NNED患者的年龄、性别、病变长度等临床病理因素差异均无统计学意义(P>0.05)。除TTF-1外,E-NED患者的Syn、Cg A、NSE、CD56、PGP9.5及SCGN表达均高于E-NNED患者(P<0.05)。在联合检测中,Syn分别与CD56、PGP9.5或SCGN构成的3种组合敏感性、阳性预测值及诊断正确率均高于Syn+Cg A组合(P<0.05)。E-NED与E-NNED患者的1、2、3年生存率差异无统计学意义(P>0.05)。结论 E-NED与E-NNED可能是不同的食管癌病理类型,PGP9.5、SCGN均可作为E-NED的诊断标志物,Syn与CD56、PGP9.5或SCGN联合检测可提高诊断敏感性和正确率。
Objective To investigate the clinicopathological features and diagnostic markers of esophageal cancer with neuroendocrine differentiation (E-NED). Methods The clinical data of 378 patients with pathologically confirmed poorly differentiated esophageal cancer from January 2008 to December 2013 were retrospectively analyzed. There were 349 patients without NED (E-NNED), 29 with E-NED, 29 with immunohistochemistry (Syn), Chromogranin A (Cg A), Neuron-specific Enolase (NSE), Nerve Cell Adhesion Molecule (CD56) in E-NED and 20 E-NNED , Protein gene product 9.5 (PGP9.5), secretin (SCGN) and thyroid transcription factor 1 (TTF-1). Results There were no significant differences in clinical pathological factors such as age, sex and pathological length between E-NED and E-NNED (P> 0.05). Except TTF-1, the expression of Syn, CgA, NSE, CD56, PGP9.5 and SCGN in E-NED patients were higher than that in E-NNED patients (P <0.05). In the combined detection, the sensitivity, positive predictive value and diagnostic accuracy of Syn with CD56, PGP9.5 or SCGN were higher than that of Syn + Cg A combination (P <0.05). There was no significant difference in the 1, 2, 3 year survival rates between E-NED and E-NNED patients (P> 0.05). Conclusion E-NED and E-NNED may be different pathological types of esophageal cancer, PGP9.5, SCGN can be used as a diagnostic marker of E-NED, Syn and CD56, PGP9.5 or SCGN joint detection can improve the diagnostic sensitivity and Correct rate.