P-gp、GST-π、TOPO-Ⅱ及LRP在胃癌组织中的表达及其对预后的影响

Significance of expression of P-gp and GST-π and TOPO-Ⅱ and LRP in gastric carcinoma and its influence in prognosis

目的：探讨P糖蛋白（P-gp）、谷胱甘肽转移酶π（GST-π）、DNA拓扑异构酶Ⅱ（TOPO-Ⅱ）及肺耐药蛋白（LRP）在胃癌组织中的表达及对预后评价的意义。方法：应用免疫组织化学方法（PV-6000法）检测P-gp、GST-π、TOPO-Ⅱ、LRP在60例胃癌组织和10例正常胃黏膜中的表达,分析其与胃癌临床病理特征的关系。将P-gp、GST-π、TOPO-Ⅱ和LRP按各自表达情况分为阳性组和阴性组,比较术后复发率、复发时间及5年存活率。将P-gp阳性、GST-π阳性、LRP阳性和TOPO-Ⅱ阴性作为4个可能与胃癌预后不良相关的危险因素进行考察,并将患者分为高危耐药组（2~4个危险因素）和低危耐药组（0~1个危险因素）,比较2组患者术后复发情况及存活率。结果：P-gp、GST-π、TOPO-Ⅱ、LRP在胃癌组织中的表达阳性率分别为53.3%（32/60）,73.3%（44/60）,83.3%（50/60）,38.3%（23/60）。它们在胃癌组织中的表达与患者的肿瘤大小、临床分期、局部浸润深度均无关（P〉0.05）,而与肿瘤的淋巴结转移及组织学类型有关（P〈0.05）。4种蛋白各自表达的阳性组与阴性组比较,术后复发率、复发时间及5年存活率的差异均无统计学意义（P〉0.05）。高危耐药组与低危耐药组比较,复发率差异无统计学意义（P〉0.05）,但复发时间早于低危耐药组,差异有统计学意义（P〈0.05）,2组患者术后5年存活率为44.0%和57.1%,差异无统计学意义（P〉0.05）。结论：P-gp、GST-π、TOPO-Ⅱ及LRP是胃癌多药耐药产生的基础,联合检测对胃癌的预后判断有重要参考价值。

Objective： To investigate the expression of P-gp,GST-π,TOPO-Ⅱand LRP in gastric carcinoma and their effects on the evaluation of prognosis of patients.Methods： The expression of P-gp,GST-π,TOPO-Ⅱand LRP in 60 cases of gastric carcinoma and 10 cases of normal gastric mucosa were examined using immunohistochemistry PV-6000 method.The expression and its relationship to the pathological data were analyzed.The postive expression of P-gp,GST-πand LRP,and the negative expression of TOPO-Ⅱ were considered as risk factors.Patients were divided into two groups：a high risk drug-resistant group（2~4 risk factors） and the low risk drug-resistant group（0~1 risk factors）.Postoperative recurrence,survival rate were compared between two groups.Results： Of the 60 cases of gastric carcinoma the positive expression rates of P-gp,GST-π,TOPO-Ⅱand LRP were 53.3%（32/60）,73.3%（44/60）,83.3%（50/60） and 38.3%（23/60）respectively.Their positive expression rates were closely relevant to lymph node metastasis and tissue typing（P0.05）,but not to the tumor size,clinical stage,depth of invasion（P0.05）.There were no significant differences in recurrence,time to recurrence,and the 5-year survival rate between the positive and negative group of the four proteins（P0.05）.There was no significant differences in the recurrence rate between the high risk drug-resistant group and the low risk drug-resistant group（P0.05）,but the time to recurrence was shorter in the low risk drug-resistant group（P0.05）.The 5-year survival rates of the high risk drug-resistant group and the low risk drug-resistant group were 44.0% and 57.1%（P0.05）.Conclusions： The expressions of P-gp,GST-π,TOPO-Ⅱand LRP in gastric carcinoma tissues exist obvious heterogeneity.Their overexpression underlie the multidrug resistance of gastric carcinoma.The joint detection of them may possess a significant clinic value in the evaluation of prognosis.