协同刺激分子B7-H3与B7-H4联合效应对胃癌患者预后的影响

Effects of B7-H3 and B7-H4 on prognosis of patients with gastric cancer

目的探讨胃癌组织中协同刺激分子B7-H3和B7-H4的表达水平对胃癌患者预后的影响及其与临床病理特征的关系。方法采用回顾性研究随访调查157例胃癌患者的相关临床资料；应用免疫组织化学染色法检测相关病理指标及胃癌患者手术标本中B7-H3、B7-H4的表达；胃癌患者不同临床特征与B7-H3、B7-H4表达水平的相关性采用，检验，不同临床特征患者的无进展生存期（PFS）及总生存期（OS）的比较采用Kaplan—Meier法及Log—rank检验，拟合多因素Cox模型，用风险比（HR）及95％可信区间（凹）估计不同临床指标与复发和死亡结局的联系强度。结果B7-H3、B7-H4表达水平与不同临床特征之间无明显相关；单因素生存分析显示年龄较大（〉60岁）、分期较晚、肿瘤较大（〉5em）、浸润较深（侵及深肌层）、远处转移及协同刺激分子B7-H4高表达等显著减少PFS及OS（P〈0．05）；多因素Cox模型分析提示，与Ⅰ期[5．58（95％CI：1．27～24．58）]比较，Ⅳ期胃癌患者复发和死亡的HR分别为6．20（95％CI：1．31～29．34）；与肿瘤直径≤5cm的患者[1．95（95％CI：1．20—3．18）]比较，肿瘤直径〉5em的患者其为1．97（95％CI：1．19～3．25）；相对于其他表达组，B7-H3低表达且B7-H4高表达的胃癌患者复发和死亡的HR分别为1．92（95％CI：1．20～3．10），1．93（95％CI：1．19—3．10）。结论B7-H3、B7-H4不同表达水平对胃癌患者PFS和OS有显著影响。

Objective To investigate the correlation between the expression level of costimulatory molecules B7-H3 and B7-H4 and prognosis of patients with gastric cancer. Methods A retrospective study was performed to investigate the clinical data of 157 patients with gastric cancer. The pathological indicators and the expression levels of B7-H3 and B7-H4 were detected by using immunohistochemistry. The correla- tion between the expression levels of B7-H3 and B7-H4 with clinical characteristics was analyzed by using chi-square test. Progression-free survival （PFS） and overall survival （OS） in patients with different clini- eopathologieal characteristics were compared by using Kaplan-Meier and Log-rank test. The Cox proportion- al hazards model was performed to estimate Hazard risk （HR） with 95% CI of the linking strength between the different clinical characteristics, expressions of B7-H3 and B7-H4 and recurrence, death risks. Results There was no obvious correlation between B7-H3 and B7-H4 expression levels and the different clinical characteristics. The results of univariate survival analysis showed that the older （ 〉 60 years ） , staging late, larger tumors （ 〉 5 cm）, deeper infiltration （myometrial invasion） , distant metastasis and B7-H4 high expression were important factors which significantly reduced both PFS and OS （ P 〈 0. 05 ）. The re- sults of Cox model showed that the HR of recurrence and death of the patients with stage IV was 6. 20 （95%CI- 1.31-29. 34） and 5.58 （95% CI. 1.27-24. 58） compared to patients with stage I. The HR of recurrence and death of the patients whose tumor size 〉5 em was 1.97 （95% CI： 1.19-3.25） and 1.95 （95% CI： 1.20-3.18） compared to the patients whose tumor size was 〈5 cm. The HR of recurrence and death in the group of B7-H3 low expression with B7-H4 high expression was 1.92 （95% CI： 1.20-3.10）and 1.93 （95% CI： I. 19-3. 10） compared to other classifications. Conclusion B7-H3 and B7-H4 ex- pression status can significantly affect the PFS and OS of gastric cancer patients. Combined detection of BT-H3 and BT-Hd may improve the prediction quality of prognosis in gastric cancer patients.