甲状腺乳头状癌ALDH1A1表达与淋巴结转移的相关性

High aldehyde dehydrogenase 1A1 （ALDH1A1） expression correlated with risk of lymph node metastasis in papillary thyroid carcinoma

目的探讨甲状腺乳头状癌（PTC）中ALDH1A1的表达情况及与淋巴结转移的相关性。方法收集首都医科大学附属北京同仁医院病理科2006年1月至2013年12月间PTC腺叶切除＋淋巴结清扫标本153例，在HE染色下观察其一般临床病理学特点（肿物直径、双侧、多灶、肿瘤边界、腺叶外浸润），并采用免疫组织化学染色EnVision法，检测癌及癌旁组织中ALDH1A1的表达情况，分析ALDH1A1表达与淋巴结转移的关系。结果在153例PTC中，84例（54．9％）发生淋巴结内癌转移，126例癌组织高表达ALDH1A1，112例癌旁组织高表达ALDH1A1。通过单因素分析，发现年龄〈45岁、肿物直径〉10mm、浸润性边缘及癌组织ALDH1A1高表达与淋巴结转移明显相关（P〈0．05）。而性别、双侧、多灶、腺叶外浸润、癌旁组织ALDH1A1与淋巴结转移无关（P〉0．05）。进一步多因素分析发现浸润性边界和癌组织ALDH1A1高表达是PTC淋巴结转移的独立危险因素（P〈0．05）。在随访的82例FFC中，局部肿瘤复发4例，5年局部复发率为4．88％，包括淋巴结肿瘤复发3例和甲状腺肿瘤复发1例，无远处转移及疾病相关死亡病例。复发病例肿瘤组织ALDH1A1均为高表达。结论ALDH1A1在PTC癌组织内高表达与淋巴结转移明显相关，可作为PTC淋巴结转移的有效预测因子，有利于改善PTC患者治疗方法及随访方案。

Objective To investigate the relationship between ALDHIA1 expression and lymph node metastasis （ LNM ） in papillary thyroid carcinoma （ PTC ）. Methods One hundred and fifty-three paraffin-embedded specimens of PTC treated in the Beijing Tongren Hospital of Capital Medical University were selected from January 2006 to December 2013. The expression of ALDH1A1 was detected in both tumor tissues and adjacent non-tumor tissues by immunohistochemistry and several elinicopathological parameters （ size, bilaterality, multifocality, tumor border and extrathyroidal extensions） were assessed by HE staining. The correlation of ALDH1 A1 expression with LNM was analyzed. Results In 153 cases of PTC, there were 82 cases with LNM, 126 cases with high ALDH1 A1 expression in tumor tissues, and 112 cases with high ALDH1A1 expression in adjacent non-tumor tissues. On univariate analysis, patient age 〈 45 years, tumor size of 10 mm or more, invasive tumor border, and high ALDH1A1 expression in tumor tissues predicted LNM in PTC （P 〈 0.05 ）, whereas gender, bilaterality, multifoeality, extra-thyroidal extensions and high ALDH1 A1 expression in adjacent non-tumor border did not （ P 〉 0. 05 ）. On multivariate analysis, invasive tumor border, high ALDH1A1 expression in tumor tissues were found to be independent predictive factors for LNM in PTC （ P 〈 0. 05 ）. After a follow-up of 42 months （ median time ）, four patients developed locoregional recurrences, but no distance recurrence or disease related death were seen in 82 patients of follow up. The estimated 5-year locoregional recurrence was 4. 88% . Of these four logcoregional recurrences, three involved lymph nodes and one involved the remaining thyroid. The ALDH1A1 expression in tumor tissues was high in all of recurrence cases. Conclusion High ALDH1A1 expression in tumor tissues is correlated with lymph node metastasis in PTC and may be used as an independent predictive factor of LNM, and may improve treatment and follow-up strategies for PTC.