p53、bcl-2和bax基因蛋白表达与眼眶泪腺腺样囊性癌的关系

Protein expression of p53, bcl-2, and bax in adenoid cystic carcinoma of lacrimal gland

目的探讨细胞凋亡控制p53、bcl-2和bax基因在眼眶泪腺腺样囊性癌中表达的作用及其临床意义。方法对天津医科大学二附属医院1962年1月至1998年1月收治的56例经手术及放疗联合治疗的眼眶泪腺腺样囊性癌资料进行回顾性分析，将其按疗效分为两组，5年内复发转移组32例和5年内无瘤生存组24例，观察其p53、bcl-2和bax基因蛋白表达情况，并以8名正常泪腺组织作为对照。结果（1）p53在腺样囊性癌组的总表达阳性率为73．2％，其中复发转移组阳性率（81．3％，26／32）与无瘤生存组阳性率（62．5％，15／24），明显高于正常泪腺组织组（8例均为阴性）的表达率（均P〈0．05）；其中复发转移组阳性率明显高于无瘤生存组，其蛋白表达与临床预后呈负相关。（2）bcl-2在腺样囊性癌的总表达率为69．6％，其中复发转移组阳性率（18／32）与无瘤生存组阳性率（21／24），明显低于正常泪腺组织组（8例均为阳性）（P〈0．05）；复发转移组阳性率明显低于无瘤生存组，其蛋白表达与临床预后呈正相关。（3）bax在腺样囊性癌组的总表达阳性率为60．7％，总表达阳性率与正常泪腺组织组（1例为阴性，7例为阳性）比较差异无统计学意义（P〉0．05）。结论p53、bcl-2和bax基因的表达均与临床预后密切相关，p53低表达和bcl-2、bax的过表达临床预后较好，检测p53、bcl—2和bax可以作为判断眼眶泪腺腺样囊性癌临床预后的有价值的参考指标。

Objective To investigate the expression of p53, bcl-2, and bax, apoptosis regulating genes, in adenoid cystic carcinoma of larcrimal gland and the roles thereof in clinical prognosis. Methods 56 patients of adenoid cystic carcinoma of larcrimal gland were divided into two groups according to the prognosis ： poor prognosis group with recurrence or metastasis within 5 years （ n = 32） and better prognosis group （n = 24） surviving tumor free within 5 years. The protein expression levels of p53, tumor suppressor gene, bax, apoptosis promoting gene, and bcl-2, anti-apoptosis gene, were analyzed by strepavidinperoxidase method. 8 cases of normal lacrimal gland tissues were used as controls. Results （ 1 ） The overall positive rate of p53 of the patients with adenoid cystic carcinoma of larcrimal gland was 73.2%, significantly higher than that of the normal controls （0, P 〈 0. 05）. The p53 positive rate of better prognosis group was 62.5%, significantly higher than that of the poor prognosis group （ 81.3%, P 〈 0. 05 ）. The protein expression of p53 in adenoid cystic carcinoma of larcrimal gland was negatively correlated with clinical prognosis. （2） The overall expression rate of bcl-2 of the patients with adenoid cystic carcinoma of larcrimal gland was 69.6%, significantly lower than that of the control group（ P 〈 0. 05 ）. The expression bcl-2 protein was correlated with better clinical prognosis. （3） The bax positive rate of the patients with adenoid cystic carcinoma of larcrimal gland group was 60. 7% , not significantly lower than the control group. The bax positive rate of the better prognosis group was 91.7%, significantly higher than that of the poor prognosis group （65.6%, P 〈 0. 05 ）. Conclusion Some apoptosis regulating genes, such as mutation-type （mt） p53 play an important role in the gene ration and development of adenoid cystic carcinoma of larcrimal gland. p53, bax, and bcl-2 proteins may act as valuable signals for clinical prognosis. The patients with over expression of bcl-2 and bax and low expression of p53 may have better prognosis than the contrary ones.