早期喉癌CO_2激光切除术后复发患者相关蛋白的表达

Expression of related proteins in early laryngeal squamous cell carcinoma patients with recurrence after CO_2 laser resection

目的分析CO_2激光切除术与喉裂开手术对治疗早期喉癌效果的差异,探讨喉癌组织中p27、PTEN蛋白对患者预后的预测价值。方法选取行CO_2激光切除术的早期声带癌标本85例(CO_2激光治疗组)及行喉裂开手术的早期声带癌标本46例(裂开组),观察两种术式患者术后复发情况。同时应用免疫组化SP法检测声带癌组织及切缘组织中p27和PTEN蛋白表达,收集临床病理资料并进行随访。结果所有患者均随访2年以上,其中85例CO_2激光治疗组14例出现局部复发,复发率16.5%;46例喉裂开术组6例出现复发,复发率为13.0%;两种术式患者的复发率差异无统计学意义(P>0.05);两组患者中无复发组术后未遵医嘱吸烟者10人,复发组术后未遵医嘱吸烟者12例,两组比较差异有统计学意义(P<0.01)。p27和PTEN蛋白在声带癌、癌旁切缘组织中阳性率分别为43.5%(57/131)、80.2%(105/131)和48.9%(64/131)、83.2%(109/131);p27和PTEN蛋白在声带癌组与癌旁切缘对照组的阳性率差异均有显著性(P<0.01)。声带癌复发组和无复发组中p27和PTEN蛋白阳性率分别为20.0%(4/20)、47.7%(53/111)和10.0%(2/20)、55.9%(62/111)。p27和PTEN蛋白在声带癌复发组与无复发组阳性率差异亦有显著性(P<0.05)。复发组与未复发组切缘组织中p27和PTEN蛋白的阳性率分别为50.0%(10/20)、85.6%(95/111)和40.0%(8/20)、91.0%(101/111),复发组与未复发组切缘组织中p27和PTEN蛋白的阳性率差异有显著性(P<0.01)。结论 CO_2激光手术和传统的喉裂开手术对于肿瘤复发率的差异无统计学意义,肿瘤手术后再次吸烟与肿瘤的复发有密切相关性。p27及PTEN蛋白阴性的患者复发率高,临床应密切随访。

Purpose To compare the therapeutic effects of CO2 laser resection and traditional split laryngeal surgery on the early laryngeal cancer, and to examine relationship between the expression of p27 and PTEN and clinical prognosis in early laryngeal squamous cell carcinoma. Methods 85 patients who underwent CO2 laser resection surgery and 46 patients who underwent split laryngeal surgery were selected and the occurrence rates after surgery were observed. SP immunohistochemical method was uesd to detect the expression of p27 and PTEN in tumor resection marginal and their surgical margine tissues. Clinical data were collected and all patients were fol-lowed up. Results In the more than two-year follow-up study, 14 of 85 patients in CO2 laser treatment group （ recurrent group） presented with local recurrence and the recurrence rate was 16. 5%, while 6 of 46 patients in split laryngeal surgery group presented with local recurrence and the recurrent rate was 13. 0%. There was no statistical significance in recurrence rate between the two groups （ P〉 0. 05）. 10 of all the none recurrent patients did not follow the doctor’s advice to quit smoking after the operation, while 12 in the recurrent patients did not, the difference between the two groups was statistically significant （P〈0. 01）. The positive rate of p27 and PTEN in laryngeal carcinoma tissues and the cancer adjacent tissues （ negative surgical margin tissues ） was 43. 5% （ 57/131 ） , 80. 2% （105/131） and 48. 9% （64/131）, 83. 2% （109/131）, respectively, with a significant difference （P〈0. 01）. The positive rate of p27 and PTEN in laryngeal carcinoma tissues of the recurrent group and non recurrent group was 20. 0% （4/20）, 47. 7% （53/111） and 10. 0% （2/20）, 55. 9% （62/111）, respectively, with a significant difference （P〈0. 05）. While the positive rate of p27 and PTEN in tumor resection marginal tissues of the recurrence group and non recurrence group was 50. 0% （ 10/20 ） , 85. 6% （ 95/111） and 40. 0% （8/20）, 91. 0% （101/111）, the difference was also statistically significant （P〈0. 01）. Conclusions There was no statistically significant difference in tumor recurrence rate between CO2 laser surgery and traditional split laryngeal surgery. Postoperative recurrence is closely related to resume smoking. The recurrence rate of p27 and/or PTEN negative patients was higher than that of the opposite ones which should be followed up closely after treatment.