胆囊良恶性病变组织中桩蛋白和碳酸酐酶Ⅸ表达及临床意义

The expression and clinical significance of Paxillin and CA IX in the benign and malignant lesions of gallbladder

目的研究胆囊良恶性病变组织中桩蛋白（Paxillin）和碳酸酐酶Ⅸ（CAⅨ）表达水平及其临床病理意义。方法108例胆囊腺癌、46例癌旁组织、15例腺瘤性息肉和35例慢性胆囊炎手术切除标本常规制作石蜡包埋切片，Paxillin和CAⅨ染色方法为EnVision免疫组化法。结果胆囊腺癌Paxillin和CAIX表达阳性率（分别为60．2％和49．1％）明显高于癌旁组织（分别为26．1％、）（x^2=15．00和23．9％、x^2=8．41，P值均〈0．01）、腺瘤性息肉（分别为20．0％、）（x^2=8．60、P〈0．01和20．0％、x^2=4．49、P〈0．05）和慢性胆囊炎（分别为14．3％、）（x^2=22．89和11．4％、x^2=15．63，P值均〈0．01）。Paxillin和CAIX表达阳性的良性病例的胆囊上皮均呈中至重度不典型增生。高分化腺癌、肿瘤最大径〈2cm、无淋巴结转移、未侵犯周围组织的病例Paxillin和CAIX表达阳性率明显低于低分化腺癌、肿瘤最大径≥2cm、淋巴结转移和侵犯周围组织的病例。经KaplanMeier生存分析发现Paxillin和CAIX表达阳性病例术后生存期明显低于阴性表达病例（x^2=5．65、P〈0．05和5．65—5．92、P〈0．01）；Cox多变量回归分析显示Paxillin和CAIX阳性表达均是反映胆囊腺癌预后不良的重要指标。结论Paxillin和CAIX表达与胆囊腺癌发生、肿瘤生物学行为及预后有密切关系，Paxillin和CAⅨ阳性表达者预后不良。

Objective To study the expression and clinicopathological significance of Paxillin and CAⅨ in the benign and malignant lesions of gallbladder. Methods The surgical resected specimens of 108 cases of gallbladder adenocarcinoma, 46 cases of peritumoral tissue, 15 cases of adenomatous polyp and 35 cases of chronic choleeystitis were routinely made paraffin embedded sections. The expressions of Paxillin and CAⅨ were stained with Envision immunohistochemistry. Results The positive rates of Paxillin and CAIX expression was significantly higher in gallbladder adenocarcinoma （60.2% and 49.1%） than those in peritumoral tissues （26.1%, x^2 =15.00, P %0.01 and 23.9%, 2.8.41,P %0.01）, adenomatous polyp （20.0%,x^2 =8.60,P%0.01 and 20.0%,X^2 =4.49,P% 0.05） and chroniceholecystitis（14.3%,x^2=22.89, P%0.01 and 11.4% ,）2 =15.63,P 〈0.01）. All the gallbladder epithelia of the benign cases with Paxillin and CA Ⅸ positive expression showed moderate to severe atypical hyperplasia. The positive expression rates of Paxillin and CA IX were significanctly lower in the cases of well-differentiated, maximal diameter of mass less than 2 cm, no lymph nodes metastasis and no surrounding tissues invasion than those of the cases with poorlydifferentiated, maximal diameter of mass over 2 cm, lymph nodes metastasis and surrounding tissues invasion. With Kaplan-Meier analysis, it suggested that the survival period after the surgery in Paxillin and CAIX positive expression cases was shorter than that of negative expression cases （2：2= 5. 65, P（0. 05,5. 65=5. 92, P（0.01）. With multivariate Cox regression analysis, it indicated that both Paxillin and CAIX positive expression was an important indicator of the poor prognosis in gallbladder adenocarcinoma. Conclusion The expression of Paxillin and CA IX may be closely related to the carcinogenesis, tumor biological behaviors, and prognosis of gallbladder adenocarcinoma. The positive expression of Paxillin and/or CAIX is associated with poor prognosis.