食管癌患者常规分割放疗前后血清p53抗体动态变化的初步研究

Sequential changes of serum p53 antibodies and its significance in radiotherapy for esophageal carcinoma

目的探讨食管癌患者血清p53抗体与临床病理特征和常规分割放疗疗效间关系，以及放疗前后p53抗体动态变化规律。方法选择未行手术及化疗的食管癌患者46例为实验对象，并选30例健康人做对照。采集放疗前1d、放疗20、40、60Gy时患者血清标本，采用酶联免疫吸附法（ELISA）检测患者血清p53抗体。结果食管癌患者血清p53阳性率明显高于正常人（39％：0；P=0．000），放疗前、放疗20、40Gy的相似（39％、39％、35％，P=1．000、0．666）），放疗前、放疗60Gy的有差别（39％、15％，P=0．010），放疗40、60Gy的有差别（35％、15％，P=0．030）。食管癌患者血清p53抗体检测的敏感性为39％，特异性为100％，符合率为63％，阳性预测值为100％，阴性预测值为52％（kappa=0．34）。食管癌患者血清053抗体阳性率与肿瘤病理分化程度、临床分期以及淋巴结转移密切相关（P=0．002、0．014、0．015），与患者性别、年龄、原发肿瘤长短、部位无关（P=0．918、0．870、0．102、0．953）。放疗有效患者的血清p53抗体阳性率显著低于放疗无效者（61％、100％，P=0．000）。结论检测血清p53抗体水平有助于食管癌的诊断；放疗前后动态测定食管癌患者血清p53抗体的变化规律，有助于判断疗效和预后。

Objective To study the relationship between serum p53 antibodies （p53-Abs） and clinicopathological characteristics or effect of radiotherapy for patients with esophageal carcinoma, and to investigate sequential changing regularity of serum p53-Abs after radiotherapy. Methods The serum p53 antibody （p53-Ab） level was examined in 46 patients with esophageal carcinoma, as well as 30 healthy adults as control by enzyme linked immunosorbent assay （ELISA）. Blood samples were collected on the day before radiotherapy and when the irradiation dose reached 20 Gy/10f/12d, 40 Gy/20f/24d and 60 Gy/30f/36d. Results The level and positive rate of serum p53-Abs in patients with esophageal carcinoma were significantly higher than those in normal individuals （P 〈0.05）. Serum p53-Ab was positive in 18 of 46 patients with esophageal carcinoma （39%）. The sensitivity, specificity, accurate rate, positive predictive value and negative predictive value of p53-Ab detection in esophageal carcinoma were 39% , 100% ,63%, 100% and 52%, with a kappa value of 0.34. The positive rate of serum p53-Abs in esophageal carcinoma was related with histological grade, disease stage and lymph node metastasis （ P 〈 0.05 ）, but not with sex, age, the size or site of tumor （P 〉 0.05 ）. The level and positive rate of serum p53-Abs had significant differences between before radiotherapy or after administration of an irradiation dose of 40 Gy/20f/24d and after administration of an irradiation dose of 60 Gy/30f/36d （P 〈 0.05 or P 〈 0.01 ）. The positive rate of serum p53- Abs in response patients with esophageal carcinoma was significantly lower than those in non-response individuals after radiotherapy （P 〈 0.05）. Conclusions Detection of serum p53-Abs is helpful for the diagnosis of esophageal carcinoma. Monitoring of sequential changes of serum p53-Abs before and during radiotherapy is helpful to evaluate the treatment response and the prognosis of patients with esophageal carcinoma.