增殖细胞核抗原在卵巢癌中表达与淋巴结转移、预后的关系

Proliferating cell nuclear antigen (PCNA) in ovarian carcinoma and its relation to lymph node metastasis and prognosis

目的探讨在卵巢上皮癌中增殖细胞核抗原（ｐｒｏｌｉｆｅｒａｔｉｎｇｃｅｌｎｕｃｌｅａｒａｎｔｉｇｅｎ，ＰＣＮＡ）的表达及其与淋巴结转移、预后和二探术结果的关系。方法用单克隆抗ＰＣ１０抗体免疫组化染色石蜡包埋的卵巢癌组织。结果全部７４例原发肿瘤和其中３１例腹腔转移肿瘤标本均显示ＰＣＮＡ阳性。在３１例转移灶中，ＰＣＮＡ表达（７．４９）较同一患者的原发灶（６．８９）要明显增高。当两侧卵巢均累及时，ＰＣＮＡ表达亦较单侧卵巢癌高（Ｐ＜０．０４）。ＰＣＮＡ表达与淋巴结转移、临床分期、组织分级、亚型无关。２８例Ⅲ期患者行二探术，阴性二探术者原发灶平均免疫反应分数（７．５９），较阳性二探术者（６．１０）显著增高（Ｐ＝０．０３）。经单因素分析，总的生存率与ＰＣＮＡ表达呈负相关，但经Ｃｏｘ模型多因素分析显示，独立的预后因素为首次减瘤术后残留肿瘤大小（Ｐ＜０．０１）和临床期别（Ｐ＜０．０５），再次是ＰＣＮＡ的表达（Ｐ＝０．０９）。结论本研究显示ＰＣＮＡ表达水平具有一定指示预后的价值，但与淋巴结转移无关。

Objective To investigate expression of proliferating cell nuclear antigen (PCNA) in ovarian epithelial cancer and its relation to lymph node metastasis, second look laparotomy (SLL) and prognosis. Methods Monoclonal antibody PC10 was used to stain PCNA in archival paraffin embedded tissues.Results PC10 immunostaining was performed successfully in all 74 primary and 31 intraperitoneal metastatic tumors. The expression of PCNA was significantly elevated in 31 metastatic tumors compared with their primary tumor from the same patient (7.94 vs 6.89, P =0.042). The expression was more marked in bilateral than in unilateral ovarian cancer but it was not associated with lymph node metastasis, clinical stage, histologic grade and subtype. In 28 patients with stage Ⅲ ovarian cancer undergone SLL, the mean immunoreactive score (IRS) of PCNA of the primary tumor was significantly higher in patients with negative SLL than in those with positive SLL (7.59 vs 6.10, P =0.03). Since chemotherapy was performed following surgical debulking, negative SLL more frequently seen in patients with high PCNA expression might suggest better chemotherapeutic sensitivity due to higher proliferation fraction of tumor cells. Univariate analysis of survival indicated that the overall survival was inversely associated with the level of PCNA expression, while multivariate analysis with Cox's model showed that independent prognostic factors were the residual tumor after primary debulking ( P < 0.001) and clinical stage ( P <0.05), followed by PCNA expression ( P =0.09). Conclusion The expression of PCNA may be useful in predicting prognosis, but is not correlated with lymph node metastasis.