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目的探讨胃癌患者术前外周血鸟苷酸环化酶C信使RNA(guanylate cyclase C,GC-C mRNA)表达与术后复发的关系。方法收集60例胃癌患者术前外周血和同期门诊15例肠上皮化生、21例异型增生患者以及20例健康体检者外周血标本,应用实时荧光定量PCR(RFQ-PCR)检测GC-C mRNA的表达,并分析其与临床病理参数及胃癌术后复发的关系。结果健康体检者外周血中未检测到GC-C mRNA表达,肠上皮化生和异型增生患者外周血GC-C mRNA表达阳性率分别为9.5%(2/15)和20.0%(3/21);而胃癌患者术前外周血阳性率为48.3%(29/60),高于健康体检者及肠上皮化生、异型增生患者(P<0.05)。胃癌患者术前外周血GC-C mRNA表达与肿瘤Laurén分型、临床TNM分期、浸润深度、淋巴结转移和分化程度等均有关(P<0.05,P<0.01)。GC-C阳性胃癌患者术后1~4年的累计肿瘤复发率分别为41.4%、79.3%、96.6%和100.0%;GC-C阴性患者术后1~4年的累计肿瘤复发率分别为16.1%、41.9%、67.7%和80.6%,且GC-C阳性患者术后中位复发时间短于GC-C阴性患者。两组患者术后1~4年的累计肿瘤复发率、中位复发时间和总体生存期差异有统计学意义(P<0.05,P<0.01)。结论胃癌患者术前外周血GC-C mRNA阳性者预后更差,且更易出现术后短期复发。
Objective To investigate the relationship between the expression of guanylate cyclase C (GC-C mRNA) and postoperative recurrence in gastric cancer patients. Methods Peripheral blood samples of 15 patients with intestinal metaplasia, 21 patients with dysplasia and 20 healthy controls were collected from 60 cases of gastric cancer patients before surgery and peripheral blood samples of 20 healthy subjects were collected. Real-time quantitative PCR (RFQ-PCR) was used to detect the expression of GC-C mRNA , And analyzed its relationship with clinical pathological parameters and recurrence of gastric cancer. Results GC-C mRNA expression was not detected in the peripheral blood of healthy controls. The positive rates of GC-C mRNA in peripheral blood of patients with intestinal metaplasia and dysplasia were 9.5% (2/15) and 20.0% (3/21) respectively, ; While the positive rate of preoperative peripheral blood in patients with gastric cancer was 48.3% (29/60), which was higher than that in healthy subjects and those with intestinal metaplasia and dysplasia (P <0.05). The expression of GC-C mRNA in peripheral blood of gastric cancer patients was correlated with Laurén classification, TNM stage, depth of invasion, lymph node metastasis and differentiation (P <0.05, P <0.01). The cumulative tumor recurrence rates of patients with GC-C positive gastric cancer 1-4 years after operation were 41.4%, 79.3%, 96.6% and 100.0%, respectively. The cumulative tumor recurrence rates of patients with GC-C negative 1-4 years after operation were 16.1 %, 41.9%, 67.7% and 80.6%, respectively. The median time to postoperative recurrence in GC-C positive patients was shorter than that in GC-C negative patients. The cumulative tumor recurrence rate, median time to recurrence and overall survival in the two groups were statistically significant between 1 and 4 years after operation (P <0.05, P <0.01). Conclusion The prognosis of gastric cancer patients with GC-C mRNA positive preoperative worse, and more prone to short-term recurrence.