胃癌组织中p53、c-erbB-2、EGFR、nm23、E-cadherin基因表达及预后价值

The expression of p53, c-erbB-2, EGFR, nm23 and E-cadherin and their prognostic value in gastric carcinoma

目的：寻找胃癌临床病理特征和预后的可靠分子指标，建立一种能被临床普遍应用的简易方法。方法：应用免疫组化法检测了具有随访资料的171例胃癌标本中p53、nm23、c-erbB－2、EGFR和E-钙粘蛋白（E－cadherin，简写为E－cad）的表达。结果：（1）Cox比例风险模型多因素分析表明，p53、c－erbB－2、EGFR和E－cad是影响胃癌预后的因子；p53、c－erbB－2及EGFR表达的胃癌病人预后差，而E－cad表达则病人预后好。（2）nm23和E－cad的表达与浸润深度显著相关，癌组织浸润越深，其表达越少（P＜0．05）；有淋巴结转移和远处转移者的p53和EGFR表达率高于无淋巴结转移和无远处转移者（P＜0．05），而有淋巴结转移和远处转移者的nm23和E－cad的表达率低于无淋巴结转移和无远处转移者（P＜0．05）。结论：（1）测定EGFR、E－cad、c－erbB－2和p53基因的表达，对临床判断病人预后及指导治疗有较大的帮助；(2)c-erbB－2和EGFR同步表达对胃癌的进展可能有协同作用。

Objective: To search for the molecular markers that can predict the clinicopathologic features and prognosis of patients with advanced gastric carcinoma and build up a simple but effective method which could be used in clinical practice. Methods: Using the immunohistochemical method, the expressions of p53, c-erbB-2, EGFR, nm23, and E-cadherin were examined on 22 cases of early gastric carcinoma (EGC ) and 149 cases of advanced gastric careinoma specimens. Results: (1) The multivedate Cox regression model indicated that p53, c-erbB-2, EGFR and E-cadherin were all independent prognostic factors in patients with advanced gastric carcinoma. A close concordance was found between the expressions of p53, c-erbB-2 and EGFR, they denoted a very poor prognosis (P < 0. 01 ); while a positive E-cadherin expression meant a very good prognosis. (2) There was a highly significant correlation between the expressions of nm23 and E-cadherin and the depth of tumor invasion. The deeper the invasion, the lower expressions of nm23 and E-cadherin (P < 0. 05). The expressions of nm23 and E-cadherin were significantly lower in patients with lymph node metastasis (P < 0. 05) and distant metastasis (P < 0. 05 ). While the expressions of p53 and EGFR were significantly higher in patients with lymph node metastasi8 (P < 0. 05) and distant metastasis (P < 0. 05). Conclusions:(1) It is helpful for predicting the prognosis and giving the assistant treatment of patients with advanced gastric carcinoma to examine the expression of p53, c-erbB-2, EGFR, and E-cadherin in gastric carcinoma spaciments. (2) The coordination between c-erbB-2 and EGFR expressions may have an impact on the development of gastric carcinoma.