圆柱瘤蛋白在胰腺导管腺癌组织中的表达及在预后评价中的作用

Expression of cylindromatosis in pancreatic ductal adenocarcinoma

目的 探讨圆柱瘤蛋白（CYLD）在胰腺导管腺癌患者癌组织中的表达及其在预后评价中的作用.方法 收集57例行根治切除术的胰腺导管腺癌患者病理标本及临床资料,电话随访患者术后生存期,并通过免疫组织化学方法检测CYLD在胰腺导管腺癌组织中的表达水平,评价CYLD对胰腺导管腺癌患者预后的影响.结果 57例胰腺导管腺癌组织中CYLD高表达（CYLD评分≥2分）34例,占59.6％;CYLD低表达（CYLD评分＜2分）23例,占40.4％.年龄、周围血管侵犯以及术前糖类抗原199、癌胚抗原、总胆红素水平与胰腺导管腺癌预后密切相关（Х^2=6.131,P=0.013;Х^2=4.094,P=0.043;Х^2 =7.188,P=0.007;Х^2=7.660,P=0.006;Х^2=8.610,P=0.003）.CYLD表达与肿瘤的周围血管侵犯呈正相关（r=0.335,P=0.008）,与术前总胆红素水平呈负相关（r=-0.379,P=0.004）.CYLD低表达的胰腺导管腺癌患者中位生存期（9.3个月）明显长于高表达患者（5.2个月）,差异有统计学意义（P＜0.05）.术前总胆红素水平升高且CYLD低表达的胰腺导管腺癌患者术后中位生存期（12.5个月）长于非此条件患者（5.2个月）（P =0.002）.结论 术前总胆红素水平升高的胰腺导管腺癌患者中CYLD表达低者行根治切除术后预后更好.

Objective To evaluate the expression of cylindromatosis （CYLD） in pancreatic ductal adenocarcinoma （PDAC）,and to identify the value of CYLD in regard with predicting the prognosis of PDAC.Method The paraffin-embedded samples and clinical data of 57 patients of PDAC undergoing radical excision were collected.Immunohistochemical staining was performed to determine the expression level of CYLD,and the prognostic value of CYLD was evaluated.Result Totally 34 patients （59.6%） showed a high expression of CYLD （CYLD score ≥ 2 scores）;23 patients （40.4%） showed a low expression of CYLD （CYLD score 〈 2 scores）.The age,vascular invasion,preoperative carcinoma antigen 199 level,preoperative carcino-embryonic antigenlevel and preoperative total bilirubin （TBIL） level were correlated with prognosis of PDAC （Х^2 =6.131,P=0.013;Х^2=4.094,P=0.043;Х^2=7.188,P=0.007;Х^2=7.660,P=0.006;Х^2 =8.610,P=0.003）.Level of CYLD was positively correlated with vascular invasion（r =0.335,P =0.008） and it was negatively correlated with preoperative TBIL level （r =-0.379,P =0.004）.Patients with low expression of CYLD had a significantly longer median survival time compared with patients with high expression of CYLD （9.3 months vs 5.2 months） （P =0.047）.Patients with high preoperative TBIL level and low expression of CYLD had a significantly longer median survival time compared with others （12.5 months vs 5.2 months） （P =0.002）.Conclusion Low expression of CYLD can indicate an improved prognosis after curative surgery in PDAC patients with high preoperative TBIL level.