原发性腹膜恶性肿瘤的免疫组化研究及其预后的相关分析

The predictive value of immunohistochemical markers for the prognosis of primary peritoneal malignancies

目的探讨原发性腹膜恶性肿瘤p53、Top2α、Ki-67和Her-2/neu的表达及其预测预后的价值。方法对1995年5月至2005年5月在北京大学人民医院治疗的21例原发性腹膜恶性肿瘤患者的石蜡组织标本,用免疫组化技术检测p53、Top2α、Ki-67和Her-2/neu的表达,分析其与化疗疗效和生存时间的关系。结果21例患者Top2α、Ki-67、p53阳性表达率均为52.4%(11/21),8例存在Top2α和Ki-67共表达;Her-2/neu全部呈阴性表达。Top2α与Ki-67表达呈显著的正相关,且均与肿瘤细胞分化等级呈显著正相关。铂类敏感组(10例)和耐药组(8例)p53阳性表达有统计学差异(3例vs7例,P=0.03)。p53阳性表达和阴性表达者的中位无进展生存时间分别为15个月和47个月,两者比较有统计学差异;p53阳性表达对总生存时间以及Top2α、Ki-67阳性表达对中位无进展生存时间和总生存时间均无显著影响。结论原发性腹膜恶性肿瘤组织中存在Top2α、Ki-67与p53的阳性表达,Top2α、Ki-67的表达与肿瘤细胞分化等级呈显著正相关,但对预后可能缺乏显著影响。p53阳性表达者中位无进展生存时间缩短,提示可能对铂类化疗耐药,预后可能较差。

Objective： To investigate the expression of p53, Top2α, Ki-67 and Her-2/ neu in primary peritoneal malignancies,and their predictive value for the prognosis. Methods： Immunohistochemistry was used to determine the expressions of p53, Top2α （ topoisomerase Ⅱ- alpha） ,Ki-67 and Her-2/neu in 21 cases of primary peritoneal malignancies treated in the People＇s Hospital,Peking University between May 1995 and May 2005. The effect of these markers on the chemotherapy response and survival was analyzed. Results： The expressions of p53, Top2α,Ki-67 were all demonstrated in 11 cases, and 8 cases showed the expression of both Top2α and Ki-67. None showed the expression of Her-2/neu. The expression of Top2α was sig- nificantly correlated with that of Ki-67, and both had significant positive correlations with histological grade. None of the expression of t）53, Top2α, Ki-67 showed a correlation with stage. A significant difference in expression of t）53 was found between the platinum-sensitive group and the platinum-resistant group. The median progression-free survival of patients with positive p53 immunostaining was 15 months,which was significantly shorter than that of patients with negative p53 immunostaining （47 months） （P 〈 0.05 ）. No obvious effect of p53 expression was observed on the overall survival. And no significant effect of Top2α and Ki-67 expression was shown either on the progression-free survival or overall survival. Conclusion：p53, Top2ct, Ki-67 are expressed in primary peritoneal neoplasms. The expression of Top2α and Ki-67 have a positive correlation with histological grade, yet neither has effect on the progression-free survival or overall survival. The median progression-free survival of patients with positive p53 immunostaining is decreased, probably suggesting a resistance to platinum-based chemotherapy and a poor prognosis.