Dukes′B期大肠癌微小转移及P53检测的临床意义

The clinical study on lymphnodes micrometastasis and p53 of colorectal cancer in Duke's stage

目的 Dukes′B期大肠癌患者手术后 5年生存率为 5 3.9%～ 84.9% ,有部分患者 5年内出现局部复发或 /和远处转移。本研究旨在探讨淋巴结微小转移灶 (lymphnodesmicrometastasisLMM)及原发灶p5 3的表达对评估经手术切除原发肿瘤及肠周淋巴结的Dukes′B期大肠癌患者预后的重要性和指导术后治疗的意义。方法 收集 5 2例Dukes′B期大肠癌患者手术切除的淋巴结及原发灶石蜡标本 ,同时获得这些病例的临床资料及随访 (生存期大于五年或死亡 )资料 ;实验方法 ;以细胞角蛋白单抗 (anti cytokerratinAE1/AE3 )为探针 ,采用免疫组化SAP(streptavidin alkalinephosphatase)法检测淋巴结中的LMM。以p5 3单抗为探针 ,采用免疫组化S -P(streptavidin peroxidase)法检测原发灶p5 3蛋白的表达。结果 检测 5 2例Dukes′B期大肠癌患者的 5年生存率为 73% ( 38/5 2 )。淋巴结中LMM +组 5年生存率 45 .5 % ( 5 /11) ,LMM 组 78.9% ( 32 /41)。原发灶中p5 3+组 5年生存率 6 2 % ( 18/2 9) ,p5 3 组 87% ( 2 0 /2 3)。同时检测LMM +p5 3+组 33% ,LMM p5 3 组 84%。X2 检验均P <0 .0 5 ,生存分析log rank检验P <0 .0 5。本实验中一般因素 (性别、年龄及肿瘤所在部位 )对检测结果的影响不明显 ;统计学处理 ,P >0 .0 5。

Objective To investigate the clinical significance of lymph node micrometastasis and p53 protein expression.Methods The paraffin-embedded lymph nodes samples of 52 pateints were collected.Then the clinical material and follow-up information of all 52 patients were obtained.The immunocytochemical staining method was SAP method to detect the micrometastasis in lymphnodes using the monoclonal antibody AE 1/AE 3,which was specific for cytokeratin antigens.The other is SP method to detect p53 protein in the primary tumor tissue using the monoclonal antibody p53.Results Micrometastases positive(LMM+) were detcted in 11 (21%) out of 52 patients.There were 13.2%(5/38)LMM+and 86.8%(33/38) mirometastasis negtive(LMM-) in 38 patients who survived more than 5-year (X 2 test, P<0.05).Survival analysis was by log-rank test,P<0.05.The p53 protein were detected in 29(56%) of 52 patients.When LMM and p53 were detected together in 52 patients,the postoperative 5-year survival rate in group LMM+ p53+were shorter than other groups.Mirometastasis in lymph nodes and p53 protein express in for patients with Dukes'B colorectal cancer was associated with decreased survival time.There were no significant difference in patients' sex,age and the location of carcinoma.(X 2 test P>0.05).Conclusion The detection of mirometastasis in lymph nodes and p53 in primary tumor tissue in patients with Dukes'B colorectal cancer by immunohistology method obviously influnced survival time with significance for guiding postoperative treatment.