影响涎腺腺样囊性癌预后因素的探讨

INVESTIGATION OF FACTORS INFLUENCING THE PROGNOSIS OF SACC

目的：研究５０例涎腺腺样囊性癌（ｓａｌｉｖａｒｙａｄｅｎｏｉｄｃｙｓｔｉｃｃａｒｃｉｎｏｍａ，ＳＡＣＣ）患者的肿瘤部位、临床分期、组织学分型及肿瘤转移抑制基因ｎｍ２３、组织蛋白酶Ｄ（Ｃａｔｈｅｐｓｉｎ－Ｄ，Ｃａｔｈ－Ｄ）、金属硫因蛋白（ｍｅｔａｌｏｔｈｉｏｎｅｉｎ，ＭＴ）、增殖细胞核抗原（ｐｒｏｌｉｆｅｒａｔｉｎｇｃｅｌｎｕｃｌｅａｒａｎｔｉｇｅｎ，ＰＣＮＡ）、肿瘤抑制基因ｐ５３的关系。方法：用免疫组织化学反应进行多因素分析，探讨它们与局部复发、远处转移和生存率的关系。结果：影响ＳＡＣＣ局部复发的因素太多，以上各指标均不能独立判断ＳＡＣＣ的局部复发情况；ｎｍ２３和Ｃａｔｈ－Ｄ与ＳＡＣＣ远处转移有明显相关性（Ｐ＜０．０５），表明ｎｍ２３和Ｃａｔｈ－Ｄ在ＳＡＣＣ远处转移中具有重要作用，是预测ＳＡＣＣ远处转移的两项独立指标；临床分期与ＳＡＣＣ患者的生存率有明显相关性（Ｐ＜０．０５）。结论：临床分期可作为一项独立作用的指标来评价ＳＡＣＣ患者的预后。

Objective: It is a focus to investigate the effective prognosis indicators of salivary adenoid cystic carcinoma (SACC) and determine the relationship between the location, clinical stage, histological type, the immunoactivity of nm23, Cathepsin D (Cath D), metallothionein (MT), proliferating cell nuclear antigen (PCNA), p53 and local recurrence, distant metastasis of the tumor and survival rate of the patients with SACC. Methods: Fifty patients with SACC aged 19～72 years(median, 45 years) were investigated. All surviving patients had a minimum of 5 years follow up(average, 8.27 years). Careful examination was to definite local recurrence and distant metastasis. The tumor site, clinical stage, histological type were reviewed. The immunoacitivity of nm23, Cath D, MT, PCNA, p53 were determined by immunohistochemistry methods. The relationship between these indexes and local recurrence, distant metastasis of the tumor and survival rate of the patients by singlevariate and multivariate analysis. Results: Singlevariate analysis showed that the expression levels of nm23, Cath D and PCNA significantly related to distant metastasis of SACC ( P <0.05); no index correlated with local recurrence of SACC ( P >0.05); clinical stages had significant relation with the survival rate of the patients with SACC ( P <0.05). Multivariate analysis showed that the above mentioned indexes had no significant relation with local recurrence ( P >0.05); the distant metastasis of SACC was significantly affected by the immunoactivity of nm23 and Cath D ( P <0.05); clinical stages had significant relation with the survival rate of the patients with SACC ( P <0.05). Conclusion: There are many factors influencing the local recurrence of SACC, the above mentioned indexes can not be independently associated with local recurrence. The nm23 and Cath D played an important role in distant metastasis of SACC and were two independent indicators of distant metastasis. Clinical stages could act as an independent indicator of the prognosis of SACC.