宫颈腺癌中Fas配体的表达对淋巴结转移和预后的影响

Relevance of fas ligand expression in cervical adenocarcinoma lymph node metastasis and prognosis.

目的研究宫颈腺癌中Fas配体(Fas ligand,FasL)的表达对肿瘤淋巴结转移和预后的影响,并初步探讨其可能的细胞生物学机制。方法35例临床分期为IB^IIB的宫颈腺癌患者,其中14例伴有淋巴结转移。对手术切除标本采用RT-PCR和免疫组化方法,在mRNA水平和蛋白质水平检测各组标本中FasL的表达情况,对结果的光密度值进行半定量分析。将FasL表达情况,与患者术后病理指标,以及生存率进行对比。结果在所有的宫颈腺癌患者中,有62.9%(22/35)的原发灶处有FasL的阳性表达;在14例淋巴结转移的标本中,有92.8%(13/14)的FasL阳性表达,其中64.3%(9/14)的标本中阳性细胞比例达50%以上。病理学检测显示,FasL的阳性表达与癌细胞对周围组织的侵袭程度,以及淋巴结转移有显著的相关性(P<0.01)。随访资料显示,FasL阳性表达的宫颈腺癌患者,5年生存率仅为54.5%(12/22),与FasL阴性表达的患者相比,具有显著性差异(P<0.01)。结论FasL阳性表达的宫颈腺癌细胞,可以诱导淋巴细胞凋亡,从而便于其向周围组织侵袭,并向淋巴结转移。由于FasL阳性表达的癌细胞更易逃脱免疫系统监视,因而这部分患者预后往往较差。

Objective To determine the relevance of Fas ligand expression in cervical adenocarcinoma to lymph node metastasis and prognosis, as well as to investigate the cytology mechanisms. Methods There were 14 cases of pelvic lymph node metastases among 35 patients of clinical stage IB and liB cervical adenocarcinoma. FasL expression in the specimens obtained from surgery was measured using RT - PCR and immunohistochemical staining. The Resultsof FasL expression at mRNA and protein levels were compared semi - quantitatively by optical density. The data of pathological factors and following - up survival rate of patients were analyzed to observe their correlation with FasL expression. Results Fasl, expression was positive in 62.9% （22/35） of primary lesions, and 92.8% （ 13/ 14） of cases with lymph node metastasis. Furthermore, 64.3% （9/14） of the metastatic cervical adenocarcinoma in the lymph nodes showed FasL positive staining in more than 50% cancer cells. Pathological analysis indicated that invasion to adjacent tissues and lymph node metastasis correlated closely with the positive FasL expression （ P 〈 0.01 ）. The five - year survival rate of patients with high FasL - expressing cervical adenocarcinomas significantly reduced to 54.5% （ 12/22 ） compared to patients with low FasL - expressing cancers （ P 〈 0. 01 ）. Conclusion FasL -expressing cervical adenocarcinomas could induce apoptosis in tumor infiltrating lymphocytes, which plays an important role in lymph node metastases. FasL allows the cancer cells to evade immune surveillance and then cause worse prognosis.