大肠癌旁粘膜细胞增殖模式与术后复发机制的探讨

The Pattern of Cellular Proliferation in Adjacent Tissue of Colorectal Cancer and Its Relation to Local Recurrence

目的：探讨大肠癌旁粘膜细胞增殖模式变化与肿瘤术后复发的关系。方法：用免疫组化染色方法对７８例大肠癌标本的癌组织、癌旁粘膜及１２例正常大肠粘膜进行ｐ５３蛋白、增殖细胞核抗原（ＰＣＮＡ）检测，并进行随访。结果：癌组织ＰＣＮＡ高表达明显高于癌旁（Ｐ＜００１），癌旁ＰＣＮＡ高表达与隐窝增殖区扩大、上移，明显影响术后第１年局部复发死亡率（Ｐ＜００１），癌组织ｐ５３蛋白阳性表达率６１５４％，癌旁为２６９２％，癌及癌旁ｐ５３阳性表达不影响细胞增殖活性及术后第一年内的复发死亡率（Ｐ＞００５）。结论：大肠癌的复发可能与大肠癌的发生一样是正常隐窝增殖分化失调的顺序过程。ＰＣＮＡ可直观表现其增殖活性及增殖模式。ｐ５３突变及表达是多中心性的，癌旁ｐ５３突变点的存在是肠癌局部复发的潜在因素。

Objective: To study the relation between the pattern of cellular proliferation in adjacent tissue of colorectal cancer and local recurrence Methods: The expression of PCNA and p53 protein were examined by immunohistochemistry in tumour tissue and adjacent tissue of 78 cases of colorectal cancer and in 12 normal colonic mucosae Results: The PCNA expression in tumour is significantly higher than that in tissue adjacent to tumour Significant differences were present in PCNA high expession and the proliferation pattern of colonic crypt of adjacent tissue and normal mucosa PCNA high expression and the expansion of colonic crypt proliferation zone showed apparent bearing on local recurrence and patients death The rate of p53 expression in tumour was 615%and that in the adjacent tissue was 219% Positive expression of p53 in tumor or the adjacent tissue did not affect the cell proliferation activity nor the fate of the tumor and the patient Conclusion: Just as the genesis of colorectal cancer the recu rrence of cancer of the colon is the result of crypt proliferation The PCNA expression is intimately related with the activity and the pattern of proliferatioin The expression and mutation of p53 are multicentric and the presence of paracancerous p53 mutation may potentiate local recurrence of a colorectal cancer