腹膜后脂肪肉瘤切除术后免疫组化标记物MDM2、CDK4、Ki-67与其预后的关系

Prognostic factors of immunohistochemical markers MDM2, CDK4, Ki-67 in retroperitoneal liposarcoma

目的探讨腹膜后脂肪肉瘤患者免疫组化标记物MDM2、CDK4、Ki-67与其预后的关系。方法收集2003年1月-2014年12月在本院接受腹膜后脂肪肉瘤切除术64例完整临床资料,根据免疫组化标记物MDM2、CDK4将其分为阳性组和阴性组,根据Ki-67结果将其分为低表达（≤10%）组和高表达（〉10%）组,分析两组间的临床病理特点及预后的差异。结果 64例中54例行根治性切除手术,10例行姑息性切除手术,中位生存时间为28个月,总体1年、3年、5年生存率分别为90.6%、78.1%、54.7%。Log-rank检验显示,MDM2（χ^2=6.298,P=0.012）、CDK4（χ^2=5.474,P=0.019）、Ki-67（χ^2=6.311,P=0.012）与腹膜后脂肪肉瘤患者预后相关,但CDK4和Ki-67并非独立影响因素（P〉0.05）;多因素分析显示,病理免疫组化标记物MDM2（RR=0.369,P〈0.05）是腹膜后脂肪肉瘤预后的独立影响因素。结论腹膜后脂肪肉瘤术后病理免疫组化标记物MDM2阳性、CDK4阳性、Ki-67高表达（〉10%）提示患者预后较差,MDM2是腹膜后脂肪肉瘤预后的独立影响因素。

Objective To identify the prognostic factors of immunohistochemical markers of MDM2, CDK4, Ki-67 for patients with retroperitoneal liposarcoma. Methods Clinical data about 64 patients with retroperitoneal liposarcoma managed with surgery in our hospital from January 2003 to December 2014 were retrospectively analyzed and patients were divided into positive group and negative group according to the immunohistochemical markers of MDM2 and CDK4, while they were also divided into low expression group（≤10%） and high expression group（〉10%） according to the result of Ki-67. The differences of clinicopathologic features and prognostic factors between two groups were compared. Results Of the 64 cases, 54 patients received radical resection, 10 cases received palliative operation, with the median survival time of 28 months and the overall 1-,3-,5-year survival rate of 90.6%, 78.1%, 54.7%, respectively. Log-Rank test showed that MDM2 positive（χ^2=6.298, P=0.012）, CDK4 positive（χ^2=5.474, P=0.019）, Ki-67 overexpression（〉10%）（χ^2=6.311,P=0.012） were associated with postoperative survival time, but CDK4, Ki-67 were not independent factors for retroperitoneal liposarcoma. Multivariate analysis showed that radical surgery（RR=2.617, P〈 0.05） and MDM2（RR=0.369, P〈 0.05） were independent prognostic indicators for retroperitoneal liposarcoma. Conclusion The immunohistochemical marker of MDM2, CDK4 positive and Ki-67 high expression are indicators of poor prognosis in retroperitoneal liposarcoma, MDM2 is an independent prognostic indicator in retroperitoneal liposarcoma.