增殖细胞核抗原蛋白表达与食管癌术前放疗预后的关系

Relationship between PCNA protein expression and the prognosis of esophageal carcinoma treated by preoperative radiotherapy

目的探讨食管癌增殖细胞核抗原（ｐｒｏｌｉｆｅｒａｔｉｎｇｃｅｌｎｕｃｌｅａｒａｎｔｉｇｅｎ，ＰＣＮＡ）蛋白表达对预后的影响，指导临床选择有效治疗方案，提高局部控制率和长期生存率。材料与方法１９７９年１１月至１９９６年１２月，１６４例食管癌患者接受术前放疗及根治性食管癌切除术。均为鳞状细胞癌。放疗采用前后两野垂直照射，肿瘤剂量３０～４０Ｇｙ，照射１５～２０次／３～４周。常规免疫组化链霉素亲和素蛋白过氧化物酶连接法（ＳＰ方法）检测ＰＣＮＡ蛋白表达。结果ＰＣＮＡ蛋白表达呈胞核内弥散分布的棕黄色颗粒，食管鳞癌呈１００％表达，阳性细胞数≤２５％为低表达，＞２５％为高表达。放疗后高表达率高于放疗前高表达率，Ｐ＝０．０３；放疗前、后ＰＣＮＡ蛋白表达对生存均有明显影响Ｐ＝０．０２、Ｐ＝０．０３，并且放疗前、后ＰＣＮＡ蛋白高、低表达的预测性不一致。结论（１）食管癌放疗后ＰＣＮＡ蛋白表达升高，可能存在加速再增殖；（２）疗前、疗后ＰＣＮＡ蛋白表达的预测性不同，可指导临床选择最有效治疗方案，可作为评价预后指标。

Purpose To study the validity of PCNA protein expression on prognosis for patients with esophageal carcinoma treated by preoperative radiotherapy in order to improve the local control and survival rates.Materials and Methods From Nov.1979 to Dec.1996,164 patients were treated by preoperative radiotherapy plus radical esophagectomy. There are 104 males and 60 females with the mean age of 51 years old.All were confirmed by pathology as squamous cell carcinoma. Anterior and posterior radiation fields were used to deliver a tumor dose of 30～40Gy/15～20F/3～4W.Immunohistochemical PCNA staining was performed using a streptavidin-biotin staining technique.Results Positive nuclei were stained diffusely or granularly brown in various intensities and all positive nuclei were counted regardless of intensity.All the esophageal squamous cell carcinoma showed positive staining PCNA.It was defined that the number of positive cells ≤25% be PCNA protein low-expression(PLE ),and >25% being PCNA protein high-expression (PHE).The PHE rates were 69.3%(106/153) and 55.8%(58/104) for the post-and pre-radiation specimens, (P=0.03). PHE showed different prognosis in pre- or post-radiation, (P=0.02 and P=0.03),respectively.The correlation signified between PCNA protein expression and the pT,pN and radiopathological changes.Conclusion (1)raising of PCNA protein expression after pre-operative radiotherapy of esophageal carcinoma may signify the repopulation of tumor cells.(2) The prognosis differed from different PCNA expression before or after radiation, it may be beneficial to select the best treatment plan and as the evaluating criteria.