增殖细胞核抗原的表达和鼻咽癌的临床相关性研究

Correlation between proliferating cell nuclear antigen (PCNA) expression and nasopharyngeal carcinoma( NPC)

目的探讨增殖细胞核抗原（ＰｒｏｌｉｆｅｒａｔｉｎｇＣｅｌＮｕｃｌｅａｒＡｎｔｉｇｅｎ，ＰＣＮＡ）的表达与鼻咽癌（ＮａｓｏｐｈａｒｙｎｇｅａｌＣａｒｃｉｎｏｍａ，ＮＰＣ）的临床分期，放射敏感性，预后的关系。材料与方法材料来源于我院１９８６年～１９９０年间诊治的１０５例ＮＰＣ病人的疗前鼻咽活检标本，重新病理切片，采用ＰＣＮＡ抗体进行ＡＢＣ法免疫组化染色，显微镜下计数阳性细胞，计算增殖指数（ＰＩ）并将所有病例按照ＰＩ值的高低以２５％为界划分为两组：高ＰＣＮＡ表达者（ＨＰＩ）＞２５％，低ＰＣＮＡ表达者（ＬＰＩ）＜２５％。１０５例ＮＰＣ病人均系初程放疗，病理均为低分化鳞癌。疗中定期用间接鼻咽镜或纤维导光镜检查鼻咽肿瘤消退情况，如鼻咽ＤＴ＜４０Ｇｙ原发肿瘤消失则视为放射敏感性肿瘤；如鼻咽ＤＴ＞４０Ｇｙ肿瘤始消退或疗终仍残存者则视为放射低敏感性肿瘤。疗后定期复查或随访，统计分析其５年生存率及死亡原因并与ＰＣＮＡ表达相对照探讨其相关性。结果１０５例ＮＰＣ组织切片全部表达ＰＣＮＡ，ＰＩ自５％～７５％不等，中位指数２９．８７％，其中ＨＰＩ４４例，ＬＰＩ６１例。ＨＰＩ所占比率随Ｔ，Ｎ分期的升高有增加的趋势但无统计学差异。ＨＰＩ者?

Purpose To study the correlation between PCNA expression and clinical staging ,radiosensitivity,prognosis of NPC. Materials and Methods One hundred and five cases of NPC were studied as to clinical staging, radiosensitivity and prognosis. Fuzhou TNM Stage was used:43 T 1 ,33 T 2,19 T 3 and 10 T 4;14 N0,35 N 1, 33 N 2,23 N 3.High radiosensitive tumor (HRS) was defined as no residual tumor at dose D T < 40 Gy under indirect mirror or fibroscopic examination, whereas Low radiosensitive tumor (LRS) as no tumor or residual at dose D T > 40 Gy.There were 36 HRS and 69 LRS. Sections of 105 NPC by formalin fixed and paraffin embedded tissue were stained with anti-PCNA monoclonal antibody using an avidin-biotin immunoperoxidase ( ABC ) method. One thousand to one thousand and five hundred cells from 105- high-power fields were scored and proliferative index ( PI ) was calculated. According to the value of PI,all patients were divided into two groups: High proliferative index (HPI)>25%, Low proliferative index ( LPI )< 25%,and 44 cases of HPI, 61 cases of LPI.Results PCNA was expressed in 100% of NPC with a mean percentage of PI as 29.87%. The percentage of HPI had a increasing tendency from low to high T and N stages, but there was no significant difference. Twenty-one cases of HPI were HRS and 15 case were LRS, whereas 23 cases of HPI were HRS and 46 cases were LRS. There was significant difference between these groups ( P<0.025 ). There were 21 cases of residual tumor at D T 70 Gy, and 4 cases of HPI, 17 cases of LPI. The difference was significant ( P< 0.05).Five-year survival rate of HPI was higher than that of LPI. The death-rate of HPI was lower than that of LPI, but there was no strong correlation( P> 0.05 ).Conclusion PCNA immunostaining is a simple and clinically useful method for estimating cell proliferation and foreseeing the radiosensitivity of NPC. There is strong correlation between PCNA expression and radio-sensitivity. NPC of HPI, being highly radiosensitive has a tendency of better prognosis.