内镜激光治疗食管和贲门早期表浅癌疗效及DNA和p53表达与预后关系的研究

Study on Efficacy of Endoscopic Laser Therapy in Patients with Early Superficial Carcinoma of the Esophagus and the Gastric Cardia and Prognostic Value of p53 Expression and DNA Ploid

目的：研究内镜Ｎｄ：ＹＡＧ激光治疗食管和贲门早期表浅癌的远期疗效和ＤＮＡ及ｐ５３表达与预后的关系。方法：对内镜激光治疗癌细胞消失的３２例食管和贲门早期表浅癌病人进行３３～７８个月（平均５５．３个月）的随访。并与１１７例早期食管癌和贲门癌的自然病程对比分析。应用ＰｒｏｄｕｃｔＬｉｍｉｔＥｓｔｉｍａｔｅ方法计算其存活率。应用免疫组化染色法检测ｐ５３表达。应用分光光度计测定癌细胞ＤＮＡ含量。结果：内镜激光治疗５年存活率为９７％，自然病程５年存活率为６７％（Ｐ＜０．０１）。ｐ５３阳性表达和ＤＮＡ非整倍体型病人的复发率分别为７６．９％和６４．３％。结论：内镜Ｎｄ：ＹＡＧ激光是治疗食管和贲门早期表浅癌的有效方法。抗癌基因ｐ５３和ＤＮＡ倍体数与病人的预后有关。

Objective:To evaluate the long-term efficacy of endoscopic Nd:YAG laser therapy in patients with early superficial carcinoma of the esophagus and the gastric cardia,and the relationship between expression of p53 protein,DNA ploid and prognosis.Methods:Thirty-two patients with early superficial carcinoma who were treated by endoscopic Nd:YAG laser and obtained the disappearance of the cancer cells were followed up for 33～78 months,with a mean of 55 3 months.The survivorship function of the 32 patients was computed with the Product Limit Estimate method,and was compared with the natural history of early carcinoma of the esophagus and the gastric cardia.The expression of p53 protein was assayed immunohistochemically,and the cytohotometric DNA analysis of esophageal and cardial cancer was performed.Results:The five-year survival rate was in 97% of the 32 patients treated with laser therapy ,in contrast to 67% (P<0 01) of the 117 untreated cases with early carcinoma of the esophagus and the gastric cardia.The recurrence rate was in 76 9% of patients with positive expression of p53 protein and in 64 3% of patients with DNA aneuploidy.Conclusions:Endoscopic Nd:YAG laser was a safe and effective therapy for early carcinoma of the esophagus and the gastric cardia,and p53 protein and DNA ploid would be valuable for predicting the prognosis.