儿童恶性脑胶质瘤P53与细胞增殖核抗原表达的预后价值

The prognostic value of P53 and proliferation cell nuclear antigen expression in malignant intracranial gliomas of childhood.

目的探讨Ｐ５３与细胞增殖核抗原（ＰＣＮＡ）在儿童恶性脑胶质瘤表达的预后价值。方法采用ＡＢＣ免疫组化方法对３３例儿童恶性脑胶质瘤Ｐ５３与ＰＣＮＡ表达进行回顾性研究。结果３３例儿童恶性脑胶质瘤中Ｐ５３表达阳性１５例（４５％），ＰＣＮＡ表达阳性２９例（８８％）。间变性星形细胞瘤、胶质母细胞瘤及髓母细胞瘤Ｐ５３蛋白表达的阳性比例分别为５／１２、９／１６、１／５，肿瘤Ｐ５３蛋白阴性者其细胞增殖活性均较阴性者高（Ｐ＜００５）；ＰＣＮＡ标记指数与肿瘤的恶性程度呈正相关（Ｐｅａｒｓｏｎ列联系数＝０．５６，Ｐ＜００１）。Ｐ５３或ＰＣＮＡ表达阳性者存活率分别显著低于Ｐ５３或ＰＣＮＡ表达阴性者（Ｐ＜００５，Ｐ＜００１）。结论Ｐ５３基因突变以及由此导致的细胞异常增殖与儿童恶性脑胶质瘤的发生和发展有关；ＰＣＮＡ能较好地反映胶质瘤的恶性程度，其表达检测对临床预后判定有重要参考价值。

Objective To investigate the prognostic value of P53 and proliferation cell nuclear antigen(PCNA) in malignant intracranial gliomas of childhood. Methods P53 and PCNA were assessed retrospectively in 33 cases of archival pediatric malignant gliomas with immunohistochemical method of avidinbiotin peroxidase complex (ABC). Results Out of 33 malignant brain gliomas mutant P53 protein was expressed in 15 cses (45%), PCNA expressed in 29 cases (88%). P53 expression was positive in 5 of 12 cases of anaplastic astrocytoma, 9 of 16 cases of glioblastoma and 1 of 5 cases of medulablastoma respectively. The cell proliferative activities in P53 positive cases were significantly higher than those of P53negative cases (P<0.05). A significant correlation of PCNA expression rate with the increase of tumor malignancy was found (Pearson contingency coefficient=0.56,P<0.01).The survival rates in patients with P53 positive or PCNA positive tumors were significantly lower than those with P53 negative or PCNA negative tumors (P<0.05,P<0.01,respectively). Conclusions The abnormal expression of P53 and cell proliferation associated with mutation are involved in the initiation and progression of pediatric malignant glioma; PCNA could reflect the degree of malignancy to a certain extent. Examination of PCNA expression is of value in evaluating prognosis of the disease.