Page 86 - 南京医科大学自然版

南京医科大学学报（自然科学版） 第46卷第5期
·708 · Journal of Nanjing Medical University（Natural Sciences） 2026年5月

·临床研究·

肿瘤相关巨噬细胞在早期胃癌中的表达及其临床病理意义

贺崇芳，李 婷，孙振涛，周晓莉，王更芳，程羽青 *
南京医科大学附属第三医院（常州市第二人民医院）病理科，江苏 常州 213164

［摘 要］ 目的：探讨肿瘤相关巨噬细胞（tumor⁃associated macrophage，TAM）在早期胃癌中的表达及其临床病理意义。方法：收
集2006年1月—2022年12月于常州市第二人民医院行根治性手术治疗的109例早期胃癌患者的临床病理信息。采用免疫组
织化学方法检测肿瘤区及癌旁非肿瘤黏膜中CD68和CD163的表达。比较肿瘤区与癌旁非肿瘤黏膜中巨噬细胞的表达差异
并分析肿瘤区 TAM 的表达与临床病理特征的关系。基于受试者工作特征（receiver operating characteristic，ROC）曲线确定的
CD163/CD68截断值进行分组，分析早期胃癌淋巴结转移的危险因素。采用ROC分析评估内镜切除治愈性评价系统（endoscopic
curability assessment，eCura）及其联合 CD163/CD68 比值对早期胃癌淋巴结转移状态的区分能力并通过 DeLong 检验比较曲线
下面积（area under the curve，AUC）差异。采用Kaplan⁃Meier法进行生存分析。结果：与癌旁非肿瘤黏膜相比，肿瘤区CD163和
CD68评分显著升高（分别为10% vs. 5%，35% vs. 10%，P < 0.001），而CD163/CD68比值显著降低（0.33 vs. 0.50，P < 0.001）。CD163/
CD68比值高与肿瘤低分化、浸润至黏膜下层及淋巴结转移显著相关（P < 0.05）。多因素分析显示，CD163/CD68比值是早期胃
癌淋巴结转移的独立危险因素（P < 0.05）。在淋巴结转移的判别方面，eCura 评价系统联合 CD163/CD68 比值的区分能力
（AUC=0.774）显著优于eCura评价系统（AUC=0.706，P=0.023）。TAM（CD163和CD68评分、CD163/CD68比值）与早期胃癌患者
5年生存率无显著相关性。结论：TAM可能参与早期胃癌的发生发展，CD163/CD68比值与早期胃癌淋巴结转移密切相关，可
作为反映肿瘤免疫微环境的指标联合eCura评价系统为早期胃癌淋巴结转移风险分层提供补充信息。
［关键词］ 早期胃癌；肿瘤相关巨噬细胞；淋巴结转移
［中图分类号］ R735.2 ［文献标志码］ A ［文章编号］ 1007⁃4368（2026）05⁃708⁃09
doi：10.7655/NYDXBNSN260084

Expression patterns and clinicopathological significance of tumor⁃associated macrophages
in early gastric carcinoma
*
HE Chongfang，LI Ting，SUN Zhentao，ZHOU Xiaoli，WANG Gengfang，CHENG Yuqing
Departments of Pathology，the Third Affiliated Hospital of Nanjing Medical University，the Second People’s Hospital
of Changzhou，Changzhou 213164，China

［Abstract］ Objective：To investigate the expression of tumor⁃associated macrophages（TAMs）in early gastric carcinoma（EGC）and
their clinicopathological significance. Methods：A retrospective analysis was conducted on 109 patients with EGC who underwent
radical gastrectomy at the Second People’s Hospital of Changzhou between January 2006 and December 2022. Expression of CD68
and CD163 was assessed by immunohistochemistry in tumor regions and paired adjacent non⁃tumor mucosa. Macrophage expression
was compared between tumor and non⁃tumor regions，and the associations between TAMs and clinicopathological characteristics were
further analyzed. The CD163/CD68 ratio was dichotomized using a receiver operating characteristic（ROC）derived cut⁃off value and
included in logistic regression analyses to identify risk factors for lymph node metastasis（LNM）in EGC. ROC analysis was further
performed to evaluate the discriminatory ability of the endoscopic curability assessment（eCura）system，both alone and in combination
with the CD163/CD68 ratio，for predicting LNM，and the DeLong test was used to compare the area under the curve（AUC）. Overall
survival was analyzed using the Kaplan⁃Meier method. Results：Compared with paired adjacent non⁃tumor mucosa，CD163 and CD68
scores were significantly higher in tumor regions（CD163：10% vs. 5%；CD68：35% vs. 10%；P < 0.001 for both），whereas the CD163/
CD68 ratio was significantly lower（0.33 vs. 0.50，P < 0.001）. A high CD163/CD68 ratio was significantly associated with poor tumor

［基金项目］ 常州市“十四五”卫生健康高层次人才培养工程（2022CZBJ079）；常州市科技支撑（社会发展）项目（CE20235064）
通信作者（Corresponding author），E⁃mail：cheng_yu_qing@sina.com.cn（ORCID：0000⁃0003⁃1806⁃9893）
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