鼻咽癌组织中EGFR和nm23基因表达与预后关系研究

Prognostic value of the expression of EGFR and nm23 in nasopharyngeal carcinoma

目的探讨表皮生长因子受体（EGFR）和转移抑制基因（nm23）表达与鼻咽癌（NPC）患者预后的相关性。方法回顾分析本院2003--2006年放疗前行鼻咽活检且资料完整的127例经病理证实的鼻咽癌患者，所有患者均采用6MVX线调强放疗联合顺铂＋氟尿嘧啶方案化疗。采用免疫组化链霉素抗生物素蛋白-过氧化物酶法（SP）检测活检标本中EGFR和nm23表达，随访5年并分析其与预后关系。结果EGFR和nm23在鼻咽癌活检标本中的阳性表达率分别为80．3％和47．2％。nm23不同表达与鼻咽癌患者发生远处转移相关（X^2=7．03，P=0．008）。全组患者5年局部控制率、总生存率（0s），无瘤生存率（DFS）分别为58．3％、53．5％、46．5％。EGFR阴性者5年0s，DFS比阳性者高（∥=8．23，P=0．004；X^2=5．25，P=0．022），nm23阳性者5年OS，DFS均比阴性者高（X^2=15．68，P=0．000；X^2=14．85，P=0．000）。Cox回归模型多因素分析显示分期、EGFR及nm23鞑均可作为判断鼻咽癌患者预后的因素（X^2=23．03、18．33、39．92，P=0．000、0．000、0．000）。结论EGFR和nm23表达与鼻咽癌患者预后密切相关，可作为预测鼻咽癌患者的预后因素。

Objective To evaluate the prognostic value of the expression of epidermal growth factor receptor （EGFR） and nm23 in patients with nasopharyngeal carcinoma （NPC）. Methods From 2003 to 2006, 127 NPC patients who had undergone biopsy before radiotherapy were reviewed retrospectively. All patients received intensity-modulated radiotherapy using 6 MV X-rays combined with platinum-based chemotherapy. Immunohistochemistry SP method was adopted to detect the expression of EGFR and nm23 in NPC biopsy specimens . The relationship between the expression of EGFR and nm23 and survival was analyzed. Results The positive rate of EGFR and nm23 were 80. 3% and 47.2% respectively. The nm23 expression was correlated with distant metastasis （ X^2 = 7. 03, P = 0. 008 ）. The 5-year estimated local control, over-all survival （OS） and disease-free survival （DFS） were 58.3% ,53.5% and 46. 5%. Patients with negative expression of EGFR had a significantly better 5-year OS, DFS （X^2 = 8.23, P = 0. 004 ;X^2= 5. 25,P--0. 022） than those with positive expression. Patients with positive expression of rim23 had a significantly higher 5-year OS （X^2= 15.68,P = 0. 000） and DFS （X^2 = 14. 85, P = 0. 000） than those with negative expression. The clinical stage, EGFR and nm23 expression were independent prognostic factors shown by Cox proportional hazard model （X^2 = 23.03, 18.33, 39.92, P = 0. 000, 0. 000, 0. 000）. Conclusions The EFGR and nm23 expression were correlated with the prognosis in NPC patients.