p16基因、人乳头瘤病毒与外阴癌变的关系

The Relationship between p16,Human Papillomavirus(HPV) and Vular Cancer

目的探讨p16基因表达缺失、人乳头瘤病毒(HPV)感染与外阴上皮内瘤变Ⅲ级(VINⅢ)、外阴鳞癌、外阴基底细胞癌及疣状癌的关系。方法采用PCR方法检测43例外阴鳞癌,23例外阴基底细胞癌,25例疣状癌,21例VINⅢ级和20例外阴正常皮肤中p16基因和HPV16DNA的阳性表达情况。结果p16基因在正常外阴皮肤中的阳性表达率为100%,在VINⅢ中为61.90%,在外阴鳞癌中为27.91%,在外阴基底细胞癌和疣状癌中未被检出,它们之间的差异有显著性(P<0.05);HPV16DNA在正常外阴皮肤和外阴鳞癌中未被检出,在VINⅢ中为90.48%,在外阴基底细胞癌中为78.26%,疣状癌中为92%,它们之间的差异有显著性(P<0.05)。p16基因在外阴鳞癌Ⅰ～Ⅱ期中阳性表达率为34.62%,Ⅲ～Ⅳ期中为17.65%,差异有显著性(P<0.05);高分化中为42.31%,与中分化和低分化的10%及0相比,差异有显著性(P<0.05);在无淋巴结转移中为34.48%,与有淋巴结转移的14.29%相比,差异有显著性(P<0.05)。结论p16基因的表达缺失与外阴癌的发生、发展密切相关,与外阴鳞癌的临床分期、淋巴结转移及分化程度降低呈正相关;外阴基底细胞癌和疣状癌的发生可能与HPV感染有关;VINⅢ可能进一步发展为外阴基底细胞癌和疣状癌。

Objective To explore the relationship between the absence of p16 gene and HPV16 DNA in vulvar intraepithelial neoplasia （VINⅢ） ,vulvar squamous cell cancer （VSCC）,basal cell carcinoma （BCC） and verrucous carcinoma （VC）. Methods PCR was used to detect p16 gene and HPV16 DNA in 43 cases of VSCCs,23 BCCs,25 VCs,21 VINⅢs and 20 normal vulvar skin. Results The positive expression rate of p16 was 100% in normal vulvar skin, 61.90% in VINⅢs and 27.91% in VSCCs, and no expression was observed in BCCs and VCs. There was significant difference between them （P 〈 0.05）. The positive expression rate of HPV16 DNA was 90.48% in VINⅢs, 78.26% in BCCs and 92% in VCs, and no expression was observed in VSCCs and normal vulvar skin （P 〈 0.05 ）. The positive expression rate of p16 was 34.62% in Ⅰ-Ⅱ stage of VSCC and 17.65% in Ⅲ-Ⅳ stage. There was significant difference（P 〈 0.05 ）. The detection of p16 was 42.31% in well-differentiated VSCC, compared with 10% in moderately differentiated VSCC and negative in poor differentiated VSCC（P 〈 0.05 ）. The detection of p16 was 34.48% in negative lymphoid node metastasis,and 14.29% in positive lymphoid node metastasis （P 〈 0.05 ）. Conclusion The absence of p16 gene is related to vulvar carcinogenesis, and has positive correlation with malignant progress of vulvar cancer,clinical stage,degree of differentiation and lymphoid node metastasis. The HPV16 infection may be related to the occurrence of VINⅢ, BCC and VC. VINⅢ may further develop to BCC and VC.