细胞DNA倍体分析在食管癌临床诊断和疾病程度及预后预测中的价值

Clinical values of nuclear DNA ploidy analysis in diagnosis, disease severity prediction of esophageal cancer

目的探讨细胞DNA倍体分析在食管癌临床诊断和疾病程度及预后预测中的价值。方法采用流式细胞术对72例食管鳞癌患者的食管黏膜组织细胞行DNA倍体分析，并将其结果与临床分期、病理检查结果相对照，分析其对肿瘤的诊断价值，同时分析DNA倍体类型与食管癌患者的临床分期、肿瘤分化程度、淋巴结转移的关系。结果对肿瘤临床分期Ⅱ期及以上病变的筛查，DNA倍体方法的敏感度为84．3％（43／51），特异度为47．6％（10／21），阳性预测值为79．6％（43／54），阴性预测值为55．6％（10／18）。随临床分期增加DNA异倍体率逐渐增加[Ⅰ期52．4％（11／21）、Ⅱ期74．2％（23／31）、Ⅲ-Ⅳ期100．0％（20／20）]，两两比较差异均有统计学意义（均P〈0．05）。低分化和未分化、中分化者肿瘤组织DNA异倍体率高于高分化者[100．0％（34／34）、90．9％（20／22）比62．5％（10／16）]，差异有统计学意义（x^2=5．41、P〈0．05，x^2=11．15、P〈0．01）。有淋巴结转移者DNA异倍体率高于无淋巴结转移者，差异有统计学意义[97．9％（46／47）比72．0％（18／25）]（x^2=8．56，P〈0．01）。结论DNA倍体类型分析方法诊断食管癌与病理检查结果有较高的符合率，其可一定程度反映疾病程度及预后。

Objective To investigate values of nuclear DNA ploidy analysis in clinical diagnosis, disease . severity assessment and prognosis prediction in patients with esophageal cancer. Methods Esophageal mucosae separated from 72 patients with esophageal squamous carcinoma were included for DNA ploidy analysis by flow cytometry. Results of DNA ploidy analysis were compared with clinical stage and pathological findings of tumor to assess the diagnostic value. Relations among DNA ploidy type, clinical stage, degree of histological differentiation and lymphatic metastasis were analyzed. Results The sensitivity and specificity of DNA ploidy analysis for esophageal carcinoma with clinical stage Ⅱ and above were 84. 3% （43/51） and 47.6% （ 10/21 ） ; the positive predictive value was 79. 6% （43/54） and the negative predictive value was 55. 6% （10/18）. The DNA heteroploid rate increased with clinical stage of tumor; there were significant differences of DNA heteroploid rate among stage Ⅱ, Ⅱ, Ⅲ-Ⅳ[52.4% （11/21）, 74. 2%（23/31）, 100.0% （20/20）] （P〈0.05）. The DNA heteroploid rate of low differentiated/undifferentiated and middle differentiated tumors was significantly higher than that of high differentiated tumor [ 100. 0% （34/34）, 90. 9% （20/22） vs 62. 5% （ 10/16 ） ] （x^2 = 5. 41, P 〈 0. 05 ; x^2 = 11.15, P 〈 0. 01 ）. The DNA heteroploid rate of lymph node metastatic tumor was significantly higher than of non-lymph node metastatic tumor[97.9% （46/47） vs 72.0% （18/25） ]（x^2 =8.56, P 〈0.01）. Conclusion Results of DNA ploidy analysis are coincident with pathological examination results in diagnosis of esophageal cancer; DNA ploidy analysis has definite value in disease severity assessment and prognosis prediction.