张力蛋白样分子CTEN在胃癌上皮间质转化中的作用和预后因素分析

The role and prognostic factors of C-terminal tensin like protein in epithelial-mesenchymal transformation of gastric cancer

目的探讨只含羧基端的张力蛋白样分子(CTEN)在胃癌上皮间质转化中的作用及预后因素分析。方法应用免疫组织化学染色法检测220例胃癌患者CTEN蛋白、E-cadherin蛋白和Vimentin蛋白的表达。结果胃癌标本CTEN阳性表达率为61. 8%(136/220),高于癌旁组织的15%(3/20),差异有统计学意义(χ2=16. 488,P <0. 01);胃癌标本E-cadherin阳性表达率为25. 5%(56/220),低于癌旁组织的85%(17/20)(χ2=30. 713,P <0. 01);胃癌标本Vimentin阳性表达率为35. 0%(77/220),高于癌旁组织的10%(2/20)。在不同的性别、年龄、部位、分化程度、肿块大小的胃癌标本中,CTEN表达差异均无统计学意义(P> 0. 05)。在不同的浸润深度,CTEN表达差异有统计学意义(χ2=54. 058,P <0. 01),伴淋巴结转移组CTEN表达率明显高于无淋巴结转移组(χ2=15. 989,P <0. 01),伴远处转移组CTEN表达率明显高于无远处转移组(χ2=4. 143,P <0. 05)。胃癌组织中CTEN与E-cadherin表达呈负相关(r=-0. 357,P <0. 01),CTEN与Vimentin表达呈正相关(r=0. 498,P <0. 01)。220例随访的胃癌患者进行生存分析,CTEN阳性表达组的中位生存时间为41. 8个月,95%的可信区间为38. 3～45. 3个月,五年累积生存率为48. 5%,CTEN阴性表达组的中位生存时间为48. 2个月,95%的可信区间为44. 0～52. 5个月,五年累积生存率为69. 0%,CTEN阳性组五年生存率明显低于阴性组(χ2=4. 884,P <0. 05)。多因素分析结果显示,CTEN阳性表达、淋巴结转移和远处转移是胃癌患者预后的独立危险因素(P <0. 05)。结论 CTEN与胃癌组织侵袭和转移呈正相关,在胃癌上皮间质转化中发挥重要作用,CTEN是胃癌预后的独立危险因素,检测CTEN基因突变对胃癌的治疗及预后评估具有重要的意义。

Objective To investigate the role of COOH-terminus tensin like molecule(CTEN)in epithelial-mesenchymal transformation of gastric cancer and its prognostic factors.Methods The expressions of CTEN,E-cadherin and Vimentin in 220 patients with gastric cancer were detected by immunohistochemical staining.Results The positive expression rate of CTEN was 61.8%(136/220)in gastric cancer specimens,higher than 15%(3/20)in adjacent tissues(χ~2=16.488,P<0.01);the positive expression rate of E-cadherin in gastric cancer specimens was 25.5%(56/220),lower than 85%(17/20)in adjacent tissues(χ~2=30.713,P<0.01);and the positive expression rate of Vimentin in gastric cancer specimens was 35.0%(77/220),higher than 10%(2/20)in adjacent tissues.There was no significant difference in the expression of CTEN between different genders,ages,size of tumors and histopathological types(P>0.05).In different infiltration depth,the CTEN expression difference were statistically significant(χ~2=54.058,P<0.01),CTEN expression rate in lymph node metastasis group was obviously higher than without lymph node metastasis group(χ~2=15.989,P<0.01),and CTEN expression rate in distant metastasis group was obviously higher than without distant metastasis group(χ~2=4.143,P<0.01).CTEN and E-cadherin expression in gastric cancer tissue showed a negative correlation(r=0.357,P<0.01),while CTEN and Vimentin expression were positively correlated(r=0.498,P<0.01).220 cases of patients with gastric cancer received follow-up.Median survival time of CTEN negative express group was 48.2 months(95%confidence interal,44.0-52.5 months),69.0%for the 5-year cumulative survival rate.The survival analysis showed median survival time of CTEN positive expression group was 41.8 months(95%confidence interal,38.3-45.3 months),48.5%for the 5-year cumulative survival rate,which were lower than that in negative group(χ~2=4.884,P<0.05).Multifactor analysis showed CTEN expression,lymph node metastasis and distant metastasis were independent risk factors for the prognosis of gastric cancer patients(P<0.05).Conclusions CTEN was positively correlated with gastric cancer invasion and metastasis,and played an important role in gastric cancer epithelial mesenchymal transformation.CTEN is independent risk factor for prognosis of gastric cancer,detection of CTEN gene mutation has important significance to evaluate the treatment and prognosis of gastric cancer.