多灶性乳头状甲状腺癌中Ki-67、Cyclin D1和Bcl-2的表达与转移复发的关系

The relationship between the expression of Ki-67,Cyclin D1 and Bcl-2 in mulitifocal papillary thyroid carcinoma and the significance of lymph node metastasis and tumor recurrence

目的分析多灶性乳头状甲状腺癌(PTC)中Ki-67、Cyclin D1和Bcl-2的表达与转移复发的关系。方法收集92例多灶性PTC,淋巴结转移和复发59例,检测Ki-67、Cyclin D1和Bcl-2在多灶性PTC及不同分区淋巴结、原发与复发的癌组织中的表达差异,结合临床病理因素,分析其与多灶PTC转移复发的关系。结果 92例多灶性PTC中54例淋巴结转移,复发33例,Ⅵ区与Ⅱ～Ⅴ区淋巴结转移、淋巴结转移与复发正相关(P<0.01)。Ki-67、Cyclin D1和Bcl-2在多灶性PTC中高表达与转移、复发有关(P<0.05),在Ⅵ区和Ⅱ～Ⅴ区转移淋巴结中表达呈正相关(P<0.05);三者在原发癌与转移灶、复发前后癌灶中的表达差异无统计学意义(P>0.05);Bcl-2和Ki-67、Cyclin D1三者表达正相关(P<0.05)。结论多灶性PTC转移复发病例中Ki-67、Cyclin D1和Bcl-2高表达,Ⅵ区与Ⅱ～Ⅴ区淋巴结转移正相关,手术方式宜选择甲状腺全切术加中央区淋巴结清扫术,术中快速病理检查,以决定是否行选择性颈外侧区淋巴结清扫,以降低肿瘤复发的危险。

Objective To study the relationship between the expression of Ki-67,Cyclin D1 and Bcl-2 in mulitifocal papillary thyroid carcinoma(PTC) and the lymph node metastasis and tumor recurrence.Methods Immunohistochemical SP method was used to investigate the expression of Ki-67,Cyclin D1 and Bcl-2 between the group 59 cases of multifocal PTC with metastases and(or) recurrence and the group without metastases or recurrence,and the risk factors were analyzed by region Ⅵ lymph nodes distinguished from regionⅡ-Ⅴ in the groups.Results In the 92 cases of multifocal PTC,54 patients with lymph nodes metastasis,48 patients with region Ⅵ and 33 patients with region Ⅱ-Ⅴ,5 patients lung metastasis.The lymph node metastasis in region Ⅵ and Ⅱ-Ⅴ is significant correlation(P<0.01).The over expressions of Ki-67,Cyclin D1 and Bcl-2 in mulitifocal PTCs were related to the lymph node metastasis and tumor recurrence(P<0.05),and the expressions in region Ⅵ and Ⅱ-Ⅴ were positively correlated(P<0.05).The expressions of the 3 markers were correlated positively(P<0.05) and had no significant difference between primary tumors and tumors in lymph node metastasis and tumors recurrence groups(P>0.05).Conclusions The high expressions of Ki-67,Cyclin D1 and Bcl-2 in mulitifocal PTCs relate to the metastasis and recurrence.The lymph node metastasis in region Ⅵ is significant correlation with regionⅡ-Ⅴ.The radical neck dissection is depeneded on the pathological examination of the central region lymph nodes.