ERCC1表达与Ⅲ期胃癌术后预后的关系

Prognostic significance of ERCC1 expression in stage Ⅲ gastric cancer

目的探讨切除修复交叉互补基因(ERCC1)蛋白在Ⅲ期胃癌中表达及其与预后的关系。方法采用免疫组化En Vision二步法检测477例Ⅲ期胃癌组织中ERCC1蛋白的表达情况,并分析其与预后的关系。结果胃癌组织中ER-CC1蛋白阳性表达率为67.1%(320/477)。ERCC1阳性表达的320例患者中,化疗组中位生存期(MST)为30.9个月,5年生存率为30%;未化疗组MST为26.3个月,5年生存率为25%,差异无统计学意义(P=0.184)。ERCC1阴性表达的157例患者中,化疗组MST为33.0个月,5年生存率30%;未化疗组MST为18.5个月,5年生存率为9%,差异有统计学意义(P=0.000)。未行术后辅助化疗的131例患者中,ERCC1阳性表达者生存时间长于阴性者(P=0.034)。Cox多因素分析显示,肿块大小、浸润深度、有无脉管神经受侵、淋巴结转移、化疗与否为胃癌的独立预后因素。结论胃癌根治术后患者ERCC1阴性表达者可从含铂方案辅助化疗中获益;ERCC1阳性可能是预后良好的指标,但应用含铂药物化疗后患者似乎未能显著延长生存。

Objective To explore the correlation between the expression of the excision repair erosseomplementation group 1 （ERCC1） and the prognosis in patients with stage Ill gastric cancer following surgical resection. Methods Immunohistoehemistry （IHC） was used to assess the expression of ERCC1 in reseeted samples obtained from 477 patients with stage Ⅲgastric cancer. The rela tion between ERCC1 expression and survival of patients was analyzed. The survival of gastric cancer patients with different ERCC1 ex pression received platinumbased chemotherapy or not was compared. Results Among 477 cases, ERCC1 expression was positive in 320 patients （67. 1% ） and negative in 157 patients （32. 9% ）. Among patients with ERCClpositive expression, the median survival time was 30. 9 months in the chemotherapy group and 96. 3 months in the control group, the 5year overall survival rate was 30% in the chemo therapy group and 25% in the control group（ P = 0. 184）. Among patients with ERCClnegative tumors, the median survival times were 33.0 months in the chemotherapy group and 18. 5 months in the control group, the 5year overall survival rates were 30% in the chemo therapy group and 9% in the control group（ P = 0. 000）. Among patients who did not receive adjuvant chemotherapy, those with ERCC1 positive expression survived longer than those with ERCClnegative expression （P = O. 034）. Cox analysis showed tumor size, invasion depth, vascular nerves invasion, lymph node metastasis and chemotherapy were independent prognosis factors for gastric cancer. Conclu sion Alter radical resection of gastric cancer, patients with ERCClnegative appear to benefit from platinumbased adjuvant chemothera py. However ERCC1positive expression could be a good prognostic factor in the patients without adjuvant chemotherapy.