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目的 探讨建立胃远端癌“分子切缘”概念的可行性。方法 应用免疫组化法对 12 2例胃远端癌切除标本 (其中 3 0例术后随访有残胃断端复发癌 )的癌周口侧粘膜的p5 3、p2 1的表达进行研究。结果 ① 60例胃癌上切端组织中复发组的p5 3、p2 1的阳性率及联合阳性表达均明显高于对照组 (P <0 0 0 5 )。② 62例胃远端癌的癌周口侧粘膜的p5 3、p2 1阳性率的变化趋势是自小弯和前 (后 )壁的近癌端向上切端逐步降低 ,并以小弯纵轴为主干向两侧逐步降低 ,其表达分布类似正态分布 ,顶峰位于小弯侧距癌肿边缘 4～ 5cm处。结论 胃远端癌上切端的p5 3、p2 1阳性表达 ,尤其是联合阳性表达与残胃断端复发癌存在显著的相关性。建立“分子切缘”概念 ,即在通常的HE染色光镜下无癌组织为阴性判定的基础上 ,应用免疫组化法检测上切端 ,以p5 3、p2 1皆为阴性表达作为上切端阴性的可行性标准
Objective To explore the feasibility of establishing the concept of “molecular margin” of gastric cancer. Methods The expression of p53 and p21 in the mucous membrane of the peritumoral mucosa of 122 distal gastric cancer resection specimens (of which 30 cases were followed up with recurrent gastric stump remnants) were studied by immunohistochemical method. Results The positive rate and positive expression of p53 and p21 in the recurrent group were significantly higher in the recurrent group than in the control group (P < 0.05). The positive rate of p53 and p21 in the peripheral mucosa of the distal gastric cancer in 2 62 cases was gradually decreased from the proximal curvature of the small crura and the anterior (retro-) wall of the anterior and posterior walls, and the minor curve was the main axis. Gradually decreased to both sides, its expression distribution is similar to the normal distribution, the peak is located in the side of the small curvature of the cancer edge 4 ~ 5cm. Conclusion The positive expression of p53 and p21 in the upper end of gastric cancer, especially the combined positive expression, is significantly correlated with the recurrent cancer in the residual gastric stump. Establish the concept of “molecular margin”, which is based on the negative judgment of normal cancer-free tissue under light microscopy using HE staining, and use the immunohistochemical method to detect the upper end of the cut, with negative expression of p53 and p21 as the upper end negative. Feasibility criteria