细胞凋亡、增殖状态及bcl-2、Bax基因表达与大肠癌的预后

Cellular apoptosis, proliferation and bcl 2 Bax expression in colorectal cancinoma and their association with tumor prognosis

目的探讨大肠癌组织原位凋亡及其抑制或促进基因ｂｃｌ２及Ｂａｘ表达水平与肿瘤生物学行为及预后的关系。方法用脱氧核糖核酸末端转移酶介导的ＴＵＮＥＬ法缺口末端标记技术和组化方法，检测７７例大肠癌组织细胞的原位凋亡（ＡＩ）、原位增殖（ＫＩ）及ｂｃｌ２、Ｂａｘ基因蛋白表达。结果大肠癌组织中ＡＩ与ＫＩ相关，有随肿瘤的进展而升高的趋势；ｂｃｌ２在高分化癌和早期癌中高表达；Ｃｏｘ模型多因素分析结果表明，ＫＩ指数及ｂｃｌ２可作为临床预后判断的指标。结论凋亡调控基因ｂｃｌ２缺失表达与大肠癌增殖。

Objective To investigate the relationship between cellular apoptosis, proliferation and bcl 2/bax expression in the tissue of colorectal cancinoma and biological behavior of the tumor. Method The apopto tic cells index(AI) in situ were identified by the terminal deoxynucleotidyl transfer mediated dUTP biotin nick end labeling(TUNEL) and immunohistologic staining for Ki 67 proliferation index(KI), bcl 2/bax protein expression was performed on archival material from 77 adenocarcinomas. Result The mean AI and KI were 5 3/45 4 in early stage cancer, 5 6/48 7 in non metastatic cancer, 6 6/55 3 in advanced cancer and 8 9/60 1 in cancer with distant metastasis respectively. There was a positive relationship between the AI and KI in each specimen. bcl 2 and bax was expressed as 54 5%,74% in carcinoma and highly differentiated carcinoma. In the univariate analysis, significantly longer survival time was observed in the subgroup of bcl 2 positive carcinoma with low AI. In the multivariate analysis, tumor stage, tumor type, KI, and bcl 2 expression were independent risk factors for prognosis. Conclusion The data indicate that abnormally exchanged AI/KI, bcl 2/bax expression appears to be an event associated with tumor progression and apoptosis might also reflect the proliferative activity of human colorectal carcinoma.