食管癌P-gp和P27表达水平及对生存的影响

Study on the expression level of esophageal carcinoma P-gp and P27 and affecting survival in the patient

目的:研究食管癌细胞多药耐药性和细胞周期调控因子表达水平及对患者生存期的影响。方法:用免疫组化方法检测了104例有随访资料的食管癌手术标本中癌细胞P-糖蛋白(P-gp)和细胞周期调控因子(P27)表达水平,并进行临床病理分析。结果:104例食管癌P-gp表达阴性70例(67.3%);阳性表达34例,其中轻度表达6例(5.7%)、中度表达18例(17.3%)、重度表达10例(9.6%)。P27表达阴性34例(32.7%);阳性表达70例,其中轻度表达7例(6.7%)、中度表达42例(40.4%)、重度表达21例(20.2%)。在生存3年以上组P-gp表达阳性占17.5%(10例),而3年内死亡组P-gp表达阳性占53.3%(24例),两组比较差异有非常显著性(P<0.0001)。P-gp过表达与癌细胞恶性生物学行为和死亡率成正相关。生存3年以上组P27表达阳性占75.8%(44例),而在3年内死亡组P27表达阳性占56.5%(26例),两组比较差异有显著性(P<0.05)。P27过表达与癌细胞恶性生物学行为和死亡率呈负相关。肿瘤的分化程度在生存组与死亡组比较差异有显著性(P<0.05)。肿瘤的浸润深度在生存3年以上组浸润全层仅占53.4%(31例),而在3年内死亡组浸润全层占82.6%(38例),两组比较差异有非常显著性(P<0.01)。淋巴结有无转移的生存组与死亡组比较差异有显著性(P<0.05)。临床分期在生存组与死亡组比较差异有显著性(P<0.05)。结论:P-gp过表达与癌细胞恶性生物学行为和死亡率成正相关。P27过表达与癌细胞恶性生物学行为和死亡率呈负相关。检测P-gp和P27表达水平可为临床提供选择化疗方案的参考依据。肿瘤的分化程度、浸润深度、淋巴结转移、临床分期是影响食管癌患者生存的重要因素。

Purpose：To understand the expression level on esophageal carcinoma cell multidrug resistsnce and cyclincontrol factors which affect survival in the patient.Methods：Immunohistochemistry was used to examine the expression level on the esophageal carcinoma cell P-glycoprotein（P-gp）and cyclin control factor（P27）in the 104 cases surgical specimens which had follow-up data,and clinical pathologic analysis was also done.Results：P-gp negative expression was found in 70/104（67.3%）cases with esophageal carcinoma and positive expression in 34 cases.Among these low-grade expression was 6 cases（5.7%）;medium expression was 18 cases（17.3%）;high expression was 10 cases（9.6%）.P27 negative expression was found in 34/104 （32.7%）cases with esophageal earcinoma and positive was 10 cases（9.6%）.P27 negative expression was found in 34/104（32.7%）cases with esophageal carcinoma and positive expression in 70 cases,among these low-grade expression was seen 7 cases （6.7%）;medium expression in 42 cases（40.4%）;high expression in 21 cases（20.2%）,P-gp positive expression was found in 10 cases（17.5%）in the 〉 three years survival group,and those who died within 3 yrs had P-gp positive expression（24 cases,53.3%）.Comparing of the two groups showed statistical significance（P〈0.0001）.P-gp over expression was related to the cancer cell biological malignant bebavior with regard to deathrate.The P27 positive expression was 44 cases （75.8%）in the 〉3 year survival stage group.and the patients who died within three years group.the P27 expression was positive in 26 cases（56.5%）（P〈0.05）.P27 over expression was not related to the cancer cell biological malignant behavior as regards death rate.Tumor differentiation degree：Comparism of the surviving group with the non-survivors had a statistical significance（P〈0.05）.Tumor invasion deep degree：In survival of over three years group whole lanina was invaded in 31 cases（53.4%）only.Whereas,in the non-survivors group the whole Iamina was invaded in 38 cases（82.6%）,（P〈0.01）.The lymph node metastasis in survival group as compared to non-survivors had a statistieal significance（P〈0.05）,as well as clinical stage（P〈0.05）.Conclusions： The P-gp over expression was positively related to cancer cell biological malignant behavior and death rate. The P27 over expression was not related to the cancer cell biological malignant behavior and death rate. It could provide a reference basis for selecting the chemotherapy protoeal. The tumor differentiation degree, invasion degree, lymph node metastasis, and its clinical stage were all important factors for patient survival.