喉鳞癌患者外周血T淋巴细胞AgNORs表达与临床相关因素的分析

Argyrophilic nucleolar organizer regions expression in laryngeal squamous cell carcinoma and its relationship with clinical factors

背景与目的:T淋巴细胞核仁形成区嗜银蛋白(argyrophilic nucleoar organizer regions,AgNORs)检测已在恶性肿瘤诊断、预后判断中得到广泛的研究和应用,检测T淋巴细胞的AgNORs含量可用于反映恶性肿瘤的预后及复发。研究发现AgNORs定量分析是咽癌、多发性骨髓瘤、男性乳腺癌和前列腺癌独立的预后因素。本研究检测喉鳞癌患者外周血AgNORs的表达,分析其与年龄、性别、临床分期、T分期、N分期、解剖分区、病理分级、切缘和复发等的相关性。方法:收集中山大学肿瘤防治中心头颈科2001年2月—2004年6月初治的喉鳞癌患者的临床资料,利用KL型图像分析系统测定喉鳞癌患者外周血T淋巴细胞AgNORs的含量;统计学分析采用SPSS 16.0软件,采用Kaplan-Meier法进行生存分析并进行Log-rank检验,因素间的相关关系采用χ2检验,多因素分析采用Cox模型。结果:AgNORs表达阳性组5年生存率(58%)较阴性组(76%)低,差异有统计学意义(P=0.048)。年龄、解剖分区、临床病理分期、T分期、N分期、切缘、复发和AgNORs阳性表达是影响喉癌预后的重要因素(P<0.05);AgNORs阳性表达与临床病理分期、T分期、复发和切缘相关(P<0.05);声门上型喉鳞癌AgNORs阳性表达与淋巴结转移相关(P=0.038),切缘阴性患者中AgNORs阳性表达与复发相关(P=0.046);年龄和复发是影响喉癌预后的独立因素。结论:术后切缘阴性的喉鳞癌患者AgNORs表达阳性推荐术后行积极治疗,声门上型喉癌中AgNORs表达阳性提示淋巴结转移的可能性大,可考虑行选择性淋巴结清扫术。

Background and purpose： Argyrophilic nucleoar organizer regions （AgNORs） has been widely used in diagnosis and prognostic in malignant tumor, AgNORs content can be used to reflect prognosis and recurrence of the malignant tumors. Studies found that AgNORs is an independent prognostic factor in pharynx cancer, multiple myeloma, male breast cancer and prostate cancer. This study aimed to examine the expression of AgNORs in laryngeal squamous cell carcinoma and analyze the relationship between the expression of AgNORs and clinical factors including age, gender, clinical stage, T stage, N stage, classification, histology grade, recurrence and incisal edge. Methods： Clinical information and the AgNORs count of 122 cases laryngeal squamous cell carcinoma patients, who were initially treated by surgery between 2001 and 2004, were collected. SPSS 16.0 software was used. Kaplan-Meier method was used for survival analysis, and log-rank test was used for data analysis; multivariate analysis was carried out using Cox proportional hazard model. Results： The positive AgNORs expression group （5-year overall survival rate： 58%） had a worse prognosis than that of negative group （5-year overall survival rate： 76%） （P〈0.05）. Age, clinical stage, T stage, N stage, classification, recurrence, incisal edge and AgNORs expression were the most important prognostic factors （P〈0.05）. The expression of AgNORs was correlated with clinical stage, T stage, recurrence and incisal edge （P〈0.05）. AgNORs expression was statistically significant differences on judging lymph node metastasis in the supraglottic laryngeal carcinoma, and it was related with recurrence in the patients of negative incisal edge. Age and recurrence were independent prognosis factors on survival in laryngeal squamous cell carcinoma patients. Conelusion： Postoperative active treatment may should be recommended for cases with AgNORs positively expressed and the incisal edge negative; and selective lymph node dissections may should be performed on supraglottic laryngeal squamous cell carcinoma with AgNORs positive patients.