宫颈癌及其癌前病变组织中p16^(INK4a)和PCNA的表达及临床意义

Evaluation of expressions and clinical significance of p16^(INK4a) and PCNA in uterine cervix carcinoma and cervical intraepithelial neoplasia

目的:探讨p16INK4a、增殖细胞核抗原(proliferating cell nuclear antigen,PCNA)在宫颈癌及其癌前病变组织中的表达及临床意义。方法:采用免疫组化SP法检测p16INK4a和PCNA在40例宫颈癌、33例宫颈上皮内瘤样变(cervical intraepithelial neoplasia,CIN)Ⅱ~Ⅲ、28例CINⅠ和10例正常宫颈组织标本中的表达。结果:1)p16INK4a在正常宫颈组织中无表达。宫颈癌或CINⅡ~Ⅲ的p16INK4a表达阳性率显著高于CINⅠ,P<0.01。CINⅠ、CINⅡ~Ⅲ和宫颈癌PCNA表达阳性率显著高于正常宫颈,P<0.01。p16INK4a、PCNA表达强度随着宫颈病变程度的加重而增高,P<0.001。2)宫颈癌不同组织学类型、病理组织分级和临床分期p16INK4a表达阳性率及表达强度差异均无统计学意义,P>0.05。在不同病理组织分级和临床分期中PCNA表达强度呈增强趋势,差异有统计学意义,P<0.05。3)p16INK4a、PCNA在CINⅠ和CINⅡ~Ⅲ组织中的表达均呈显著正相关,P<0.01。结论:CINⅠp16INK4a阳性表达是其发生质变的信号,PCNA可作为宫颈细胞异常增殖的灵敏标志。联合检测宫颈病变组织中p16INK4a和PCNA的表达有助于对宫颈癌前病变进行早期诊断。

OBJECTIVE： To evaluate the expressions and clinical significance of p16^INK4a and PCNA in uterine cervix carcinoma （UCC） and cervical intraepithelia[ neoplasia （CIN）. METHODS： The immunohistochemica[ staining S-P method was used to detect the expressions of p16^INK4a and PCNA in 40 cases of UCC, 33 cases of CIN Ⅱ -Ⅲ ,28 cases of CIN Ⅰ and 10 cases of normal cervix tissues. RESULTS： 1）There was no positive expression of p16^INK4a in normal cervix tissues. There were statistically significant differences between the positive expression percentage of p16^INK4a in UCC and that in CIN Ⅰ , P〈0.01, and between the positive expression percentage in CIN Ⅱ -Ⅲ and that in CIN Ⅰ , P〈0.01, respectively. The positive expression percentage of PCNA in UCC, CIN Ⅱ - Ⅲ and CIN Ⅰ were significantly higher than those in normal cervix, P〈0.01. p16^INK4a and PCNA intensities were below the order： CIN Ⅰ 〈CIN Ⅱ - Ⅲ （UCC,P〈0. 001. 2）The positive expression statistically and intensity of p16^INK4a did not show statistically significant difference in different histological types, histological grades and clinical stages,P〉0.05, while that of PCNA showed a significant increase along with the progression of histological grades and clinical stages of UCC, P〈0.05. 3）There were significant positive correlations between the expressions of p16^INK4a and PCNA in CIN Ⅰ and CIN Ⅱ - Ⅲ ,P〈0.01. CONCLUSIONS： CIN I which expresses p16^INK4a has malignant pronenesses. PCNA may be used as a sensitive indicator for abnormal proliferation in CIN and UCC. The investigation of p16^INK4a and PCNA may be used as a supplementary test for screening and routine diagnostics of cervical lesions in clinics.