食管癌术前放疗后PCNA蛋白表达的改变及预后

PCNA Prediction of Prognosis of Esophageal Squamous Cell Carinoma with in Preoperative Radiotherapy

目的 探讨放疗对食管癌ＰＣＮＡ蛋白表达的影响，指导临床选择有效治疗方案。方法在我院接受术前放疗及根治性食管癌切除术的９１ 例食管癌患者，前后两野垂直照射，肿瘤剂量３０～４０Ｇｙ１５ ～２０ 次３ ～４ 周。用免疫组化ＳＰ方法检测。结果 食管鳞癌呈１００ ％ ＰＣＮＡ 蛋白表达，放疗后高表达率７１－４％ 高于放疗前的５７－１ ％ ，Ｐ＝ ０－０４ ；疗后ＰＣＮＡ 高表达者较低表达者预后明显差，Ｐ＝ ０ ．０００１ ；比较同一病人放疗前、后ＰＣＮＡ蛋白表达，显示放疗后下降者、升高者和不变者的预后均有显著性差别，Ｐ＝ ０ ．００００１ 。结论 ①疗后ＰＣＮＡ蛋白表达升高，可能存在肿瘤细胞加速再增殖②ＰＣＮＡ高表达者预后很差；而放疗后与疗前相比，下降者生存最好，有可能成为评价预后指标。

Objective To study changes PCNA in radiotherapy of esophageal carcinoma and analyse the validity of PCNA expression on prognosis.Methods From Nov.1979 to Dec.1996,91 patients were treated by preoperative radiotherapy plus radical esophagectomy in our hospital.All were confirm as squamous cell carcinoma.Two vertical irradiation fields to deliver a dose of 30～40GY/15～20F/3～4W and PCNA with immunohistochemical staining.Results The overexpression rates wree 71 4% and 57 1% for the post and pre radiotherapy, P =0.04.The survival rate of overexpression were lower than those lowexpression in post radiation, P =0.0001.The various changes of PCNA between pre and post radiation,show different survival rates, P =0.00001.The survival time differed with different reduction of PCNA indexes.Conclusion ① PCNA protein expression rise after pre operative radiotherapy of esophageal carcinoma,may signify the repopulation of tumor cells.② The survival periods were poor for patients with overexpression and the prognosis was good for patients who show a conspicuous reduction of PCNA index after radiotherapy.