多灶性甲状腺乳头状癌中CD44v6和Survivin的表达及其意义

Significance and expression of CD44v56 and Survivin in multifocal papillary thyroid carcinoma

目的探讨多灶性甲状腺乳头状癌（PTC）中CD44v6和Survivin的表达及意义。方法应用免疫组织化学SP法检测47例多灶性PTC中CD44v6和Survivin的表达，并与其癌旁组织及同期122例单灶PTC对照，比较不同临床因素中CD44v6、Survivin表达差异，及CD44v6、Survivin两者在多灶PTC中表达的相关性。结果多灶性PTC占同期PTC的27．8％（47／169），与家族史、淋巴结转移、腺外浸润有关（X^2=4．189，X^2=6．159，X^2=4．079，均P〈0．05），而与性别、年龄、是否是微小癌及癌灶大小无关（均P〉0．05）。多灶性PTC中CD44v6和Survivin阳性表达率为70．2％（33／47）和66．0％（31／47），癌旁组织均为2．1％（1／47），差异均有统计学意义（X^2=47．184，P=0．000；x^2=42．641，P=0．000）；CD44v6和Survivin的表达与有无腺外浸润（x^2=4．723，P=0．030；X^2=4．023，P=0．045）、有无淋巴结转移（X^2=5．771，P=0．016；x^2=5．686，P=0．017）有关，而与性别、年龄、家族史、是否是微小癌、病灶数目无关（均P〉0．05）；多灶PTC中癌灶间CD44v6和Survivin的表达差异无统计学意义（均P〉0．05）；CD44v6和Survivin在多灶PTC中的表达呈正相关（x^2=10．154，P〈0．01）。术后随访5年。9年9个月，两组PTC患者均健在。结论多发癌灶是PTC的临床特征之一，CD44v6和Survivin在多灶性PTC中高表达，与多灶PTC的发生、侵袭和转移密切相关。

Objective To study the relationship between clinical-biological significance and the expression of CD44v6 and Survivin in multifocal papillary thyroid carcinoma （PTC）. Methods Immunohistochemical SP method was used to investigate the expression of CD44v6 and Survivin in 47 cases of multifocal PTC and adjacent tissues, and 122 cases of single focal PTC tissues. The expression of CD44v6 and Survivin and the risk factors among different clinical factors were analyzed between solitary PTC and multifocal PTC group. Results Tumor loci were found in 27.8 % （47/169） patients. The patients with muhifocal were characterized by a higher ratio of family history of thymid tumor, lymph node metastasis and extra-thymida] extension （X2 = 4.189, 6.159, 4.079, P 〈0.05）, and not related with sex, age, size and the number of the tumors （P 〉0.05）. The positive rates of CD44v6 and Survivin were 70.2 % （33/47） and 66.0 % （31/47）, respectively, in multifocal PTC, both of which were significantly higher than that in nodular goiter, Hashimoto＇s thyroiditis and normal thyroid tissues （X2 =47.184, P 〈0.05）. Overexpressions of CD44v6 and Survivin in muhifocal PTC were related to the degree of the infiltration（x2 = 4.723, P =0.030; X2 =4.023, P =0.045） and lymph node metastasis （X2 =5.771, P =0.016; ）（2 =5.686, P =0.017）, and not related with sex, age, family history and the number of the tumors （P 〉0.05）. The expression of CD44v6 was correlated positively with Survivin （r =0.514, R2 =10.15, P 〈0.01）. There was no significant difference in expressions of CD44v6 and Survivin between muhifocal and single focal PTC （P 〉0.05）. By the sept. 2010, the patients with single and mutiple focal PTC were all survival. Conclusion Multifocus is one of the clinical features of PTC. The high expressions of CD44v6 and Survivin in muhifocal PTCs relate to the development, invasion and metastasis.