检测MTA1表达用于判断pNO食管鳞癌术后淋巴结转移

Judging the postoperative lymph node metastasis of esophagus cancer patients with pNO stage bydetecting MTA1 protein expression

目的检测肿瘤转移相关基因MTA1蛋白在pN0食管鳞癌患者手术清扫淋巴结中的表达水平，探讨其用于评估术后淋巴结转移的可行性。方法收集2008年1月至2009年10月间苏州大学附属第二医院胸心外科手术切除且经病理证实的食管癌组织及其术中相应清扫的淋巴结组织共241例。术后病理证实全部为鳞癌；剔除淋巴结转移病例，pN0患者为82例。应用免疫组织化学方法检测80例食管鳞癌患者术中清扫淋巴结MTA1蛋白的表达，结合临床病理特征及随访资料进行分析。结果（1）不同性别、年龄及组织学分化程度组间：淋巴结转移与否比较，差异无统计学意义（P〉0．05）；不同T分期间：淋巴结转移与否比较，差异有统计学意义（P〈0．05；X2=13．29）。（2）不同性别、年龄组间：MTA1蛋白无／低表达与高表达相比较，差异无统计学意义（P〉0．05）；低分化食管癌患者较高／中分化患者，MTA1蛋白呈高表达，差异有统计学意义（P〈0．05；X2=18．61）。MTA1蛋白在Tlb及T3患者淋巴结中均呈现较高表达，与T1a患者相比较，差异有统计学意义（P〈0．01；0=25．54）。（3）淋巴结转移曲线显示MTAl蛋白无／低表达者术后短期淋巴结转移率较MTA1蛋白高表达者明显为低（P〈0．05；0=16．63）。（4）Cox比例回归多因素相关分析结果显示T分期、MTA1蛋白表达水平是pN0食管鳞癌术后淋巴结转移的独立危险因素。结论检测淋巴结MTA1蛋白表达有助于判断pN0食管鳞癌术后淋巴结转移，进而指导食管癌术后辅助治疗。

Objective To investigate the feasibility for judging the postoperative lymph node metastasis of esophagus cancer patients with pN0 stage by detecting the protein expression of metastasis- associated protein 1 （MTA1）. Methods Immunohistochemistry was used to detect the expression of MTA1 protein in lymph node of esophageal squamous cell carcinoma （ESCC） with pN0 stage. Results （ 1 ） There were no significant differences in age, gender and differentiation among the lymph node metastasis （P 〉 0. 05 ）, but not with pT stage （ P 〈 0.05 ; X2 = 13.29）. （2） There were no significant differences among the expression of MTA1 protein and age, gender and differentiation （P 〉 0.05 ）, but not with differentiation and pT stage （P 〈0.05 ; X2 = 18.61 ）. Both stages pTlb and pT3 had higher expression of MTA1 protein than stage pT1 a （P 〈 0.05 ; X2 = 25.54）. （3） The curve of lymph node metastasis showed that the patients with no/lower MTA1 protein expression had a lower metastasis rate than those a higher MTA1 protein expression （P 〈 0.05; X2 = 16.63 ）. （4） The results of multivariate analysis confirmed that T status and MTA1 protein over-expression were independent risk factors for pN0 stage ESCC. Conclusion Detecting MTA1 protein expression is helpful for judging the lymph node metastasis of ESCC patients with pN0 stage. And its over- expression may used as a guide in the decision-making of postoperative adjuvant therapy.