鼻咽癌组织中Ki-67表达的阳性单位与癌转移、TNM分期及患者生存时间的关系

Association of expression of ki67 with metastasis,TNM staging and survival in patients with nasopharyngeal carcinoma

目的观察ki67在鼻咽癌组织的表达,从量化角度阐明其在鼻咽癌组织中表达的病理学意义。方法常规石蜡包埋、HE切片确诊,用免疫组化SP法检测ki67在鼻咽癌细胞核中的定位和表达,用Leica Q500MC图像分析系统对其表达强度进行定量分析,并用阳性单位(positive unit,PU)反映其表达强度。结果 ki67在鼻咽癌组织中的阳性表达主要定位在细胞核,ki67阳性细胞为核境界清晰的棕色、棕褐色颗粒沉着细胞。本研究显示ki67表达与鼻咽癌患者有无颈淋巴结转移、治疗方式不具有相关性,经统计学检验ki67与鼻咽癌患者有无远处转移、生存期及临床分期有相关性,数据具有统计学意义。有远处转移的PU值(21.00±5.95)高于无远处转移者(16.82±4.55),t=-3.069,P=0.004,两者的数据具有统计学意义;我们发现不同生存期患者的表达量均有不同,随着生存期的延长,ki67的阳性表达强度逐渐减弱。生存期3年以下PU值(24.39±4.50)高于生存期3～5年的(17.69±2.61),生存期3～5年的PU值高于生存期超过5年的(15.10±3.51),三组之间PU值差异具有统计学意义(F=45.484,P=0.000)。随着临床分期I、II、III、IV期的顺序,鼻咽癌患者的ki67的阳性表达强度逐渐增强,PU值逐渐加大,组间差异具有统计学意义(t=7.271,P=0.002)。说明ki67表达阳性者多出现在NPC的晚期。结论 ki67蛋白表达程度对于判断鼻咽癌患者是否存在远处转移和患者生存时间具有重要价值,表明Ki67可作为判定鼻咽癌的恶性程度和预后的指标之一。

Objective To quantitatively detect the expression of ki67 gene in nasopharyngeal carcinoma, and clarify its clinicopathological significance in this disease. Methods A total of 79 cases of easopharyngeal carcinoma were included in this study. The paraffin-embedded, HE stained slices of the tumor tissue were used for histopathological diagnosis. The ki67 expression and localization in the cancer cell nuclei were detected by immunohistochemical staining and quantitatively analyzed using a Leica Q500MC image analysis system. Single positive bit （positive unit, PU） was used in the analysis of Ki67 expression level. Results The expression of ki67 in the carcinoma tissue was mainly localized in the cell nuclei. Most ki67-positive cells depicted a clears nuclear contour with intranuclear deposition of numerous brown granules. The results showed that Ki67 was not related with lymph node metastasis and treatment, but had a significant association with distant metastasis, survival time and clinical staging. The PU value of cases with distant metastasis （21.00±5.95） was significantly higher than that in patients without distant metastasis （16.82±4.55）, （t = -3.069, P = 0.004）. The positive Ki67 expression was decreased the survival prolonged. The PU value of the group with survival period under 3 years （24.39±4.50） was significantly higher than that of the 3-5 years survival group （17.69±2.61）, which was in turn higher than that of patients surviving longer than 5 years （15.10±3.51）, with a statistically significant difference （F = 45.484,P = 0.000）. The expression of Ki67 in NPC patients gradually increased in an order from stage I to stage IV, showing a higher positive expression in patients with advanced disease, with a significant difference among the four groups （t = 7.271, P = 0.002）. Conclusion The results indicated that analysis of Ki67 protein expression had significant value in prediction of distant metastasis and survival in patients with nasopharyngeal carcinoma, and it might become one of useful indicators in assessment of the malignant degree and prognosis of nasopharyngeal carcinoma.