CD40表达与胃癌患者预后的关系

Expression of CD40 in human gastric cancer tissue and its prognostic correlation

目的探讨CD40在胃癌组织中的表达及其与胃癌患者预后转归的关系。方法采用免疫组化法检测73例胃癌组织和51例正常胃黏膜组织中CD40的表达，利用RT—PCR法分别检测11例胃癌和正常胃黏膜组织中CD40mRNA的表达。应用Kaplan-Meier法和Log-Rank检验评价CD40与胃癌患者生存时间的关系，并用Cox风险模型进行多因素分析。结果免疫组化检测显示CD40在胃癌组织中的阳性表达率为47．9％（35／73），与正常胃黏膜组织相比，差异有统计学意义（P=0．0063）；RT-PCR检测发现CD40mRNA在胃癌组织中的阳性表达率为72．7％（8／11），在正常胃黏膜组织中无表达。随访5年后，CD40阴性组存活57．9％（22／38），CD40阳性组存活5．7％（2／35），差异有统计学意义（P=0．0022）。胃癌组织中CIM0阴性表达、弱～中等阳性表达和强阳性表达患者中位生存时间分别为56、29和11个月，生存率差异有统计学意义（P=0．0085）。Cox回归多因素分析显示，CD40表达、淋巴结转移及临床分期是影响胃癌患者预后的独立因素。结论CD40在胃癌组织与正常胃黏膜中差异表达，可能参与胃癌的转移扩散，可作为预测胃癌患者预后的重要指标。

Objective To investigate the expression of CD40 in gastric cancer and explore the correlation of CD40 with the outcome of patients. Methods The expression of CD40 was examined by immunohistochemistry in human gastric cancer tissues （73 cases） and adjacent normal gastric tissues （51 cases）. CD40 mRNA was detected by RT-PCR in 11 gastric cancer and 11 adjacent normal gastric tissues. The patients were followed up for 60 months. The correlation of CD40 expression and the overall survival time were evaluated by Kaplan-Meier chart and Log-Rank test. Cox model was used for multivariate analysis. Results The immunoreaetivity of CD40 increased in 35/73 gastric cancer tissues （47.9%） as compared to the tumor-free tissues （P = 0. 0063）. CD40 mRNA were detected in 72.7% （8/11 ） gastric cancer tissues, while not in all tumor-free tissues. After a 5-year follow-up, the survival rate was 57. 9% （22/38） in CD40- negative patients, and 5.7% （2/35） in CD40-positive patients （P =0. 0022）. The median survival time of patients with negative, positive, and strong CD40 expression was 56, 29 and 11 months respectively （ P = 0. 0085）. Cox regression analysis suggested that CD40, lymph node metastasis and TNM stage were independent factors affecting the prognosis of gastric cancer patients. Conclusion Normal and malignant gastric tissues are found to have its own unique CD40 expression patterns. CD40 may play a role in metastatic spread of gastric cancer and its expression may be used as an important survival predictor in human gastric cancer.