进展期胃腺癌淋巴转移与相关基因表达关系

Relationship of lymphatic metastasis with the expressions of relative genes in advanced gastric adenocarcinoma

目的探讨进展期胃腺癌胃周区域淋巴结(LN)和腹主动脉旁LN转移规律。方法行survivin,p53,C-erbB-2,PCNA,Ki-67,MMP-2,MMP-7及MMP-9免疫组化染色。单因素和多因素分析上述指标与胃腺癌胃周区域LN和腹主动脉周围LN的转移的关系。结果238例中转移LN平均(5.61±0.68)枚/例,平均总LN转移度(27.78±24.45)%。238例中的207例有LN转移,总转移率86.97%。D3术53例中,13例(24.53%)有16组LN转移。手术切除的16组LN数平均(6.36±1.83)枚/例,转移LN有58枚,平均(4.46±2.05)枚/例。16组LN转移度为24.52%。单因素分析显示,LN转移与p53阳性和survivin阳性的联合表达有非常显著性关系(P<0.01)。多因素分析显示,p53和survivin阳性的联合表达是影响胃周区域淋巴转移的独立危险因素。Ki-67增殖指数(LI)及MMP-2表达提示16组LN转移(均P<0.05);Ki-67LI和MMP-2表达是影响16组LN转移的独立危险因素。结论p53阳性和survivin阳性的联合表达或可预示LN转移。Ki-67LI和MMP-2是16组LN转移的预测因素,而Ki-67LI和MMP-2表达是16组LN转移的独立危险因素。

Objective To study the regulatory factors of perigastric and para-aortic lymph node （LN） metastasis in gastric adenocarcinoma. Methods Immunohistochemical staining for the expressions of survivin, p53, C-erbB-2, PCNA, Ki-67, MMP-2, MMP-7 and MMP-9 was done and those were used to analyse the relation with lymph node metastasis by analysis of single and multiple variables. Results The average number of metastasized LN was （5. 61 ± 0. 68 ）/case in 238 cases, which was （27. 78 ± 24. 45 ） % as an average rate of LN metastasis. The LN metastasis was found in 207 of the 238 cases（ total metastasized rate： 86.97% ）. Among 53 cases with D3 operation, 13 cases（24.53% ） had para-aorta LN metastasis. The average number of para-aorta LN harvested was （ 6.36 ± 1.83 ）/case. There were 58 metastasized para- aortic LN, an average of （ 4.46±2.05 ） / case. The metastasized rate of para- arota LN was 24.52%. The combined positive expressions of p53 and survivin had significant relation with LN metastasis （P 〈0.01 ） by single analysis and was an independent risk factor for perigastric LN metastasis by multiple analysis. The Ki-67 labeling index （LI） and the MMP-2 expression indicated para-aortic LN metastasis （ P 〈 0.05, respectively ） and were independent risk factors for para-aortic LN metastasis. Conclusions The combined expressions of p53 and survivin could be used as predictive factors for LN metastasis. Ki-67LI and MMP-2 expression are predietive factors and independent risk factors for para-aorta LN metastasis.