喉鳞状细胞癌及癌前病变R0切除术后复发危险因素研究

Risk Factors for Laryngeal Squamous Carcinoma and Recurrence after R0 Resection of Precancerous Lesions

目的:分析中国医学科学院肿瘤医院95例喉癌及癌前病变患者病例资料,结合肿瘤分子标志物(p53、cMyc、PTEN、survivin、p21和p27)蛋白表达情况及临床病理因素,对喉癌及癌前病变R0切除后的复发进行分析,探讨与之相关的危险因素。方法:收集1999年1月至2015年12月R0切除术后的喉鳞状细胞癌或声带鳞状上皮不典型增生、原位癌病例95例,包括复发41例,未复发54例。应用免疫组化方法进行p53、c-Myc、PTEN、survivin、p21和p27蛋白的表达检测。结果:喉癌和癌前病变术后复发组与未复发组c-Myc、survivin及PTEN的表达差异有统计学意义(P<0.05),T1分期的复发与未复发的肿瘤c-Myc、survivin表达差异亦有统计学意义(P<0.05)。喉癌术后复发组与未复发组p21、p27及p53的表达差异无统计学意义(P>0.05)。喉癌术后复发与肿瘤病理分化程度相关;与年龄、性别及是否饮酒、吸烟的相关性无统计学意义。肿瘤病理分化程度越差,术后复发可能性越大。结论:影响喉癌和癌前病变R0切除术后复发的因素复杂。本研究提示肿瘤分化程度、c-Myc、survivin及PTEN等蛋白表达与喉癌术后复发有一定相关性,或可作为术后复发的预警指标。

Objective: To investigate the factors for recurrence of laryngeal carcinoma, 95 cases of laryngeal carcinoma and precancerous lesions were retrospectively reviewed according to protein expression of carcinoma markers (including p53 , c-Myc, PTEN, survivin, p21 and p27 proteins) and clinicopathologic factors. Methods: Ninety-five patients with laryngeal carcinoma and vocal cord squamous epithelial precancerous lesions were collected in Cancer Hospital Chinese Academy of Medical Sciences from January 1999 to December 2015. Three years after R0 resection, recurrence occurred in 41 of the 95 patients. Immunohistochemical methods were used to detect the expression of p53 , c-Myc, PTEN, survivin, p21 and p27.Results: There was significant difference between the recurrence group and the nonrecurrence group in the expression of c- Myc, survivin and PTEN ( P<0.05 );there was no significant difference in the expression of p21, p27 and p53 ( P>0.05 ). Recurrence of laryngeal carcinoma after operation was correlated to pathological differentiation of tumor, and was not statistically related to age, gender and alcohol consumption and smoking. The worse the differentiation of tumor was, the higher the recurrence rate was. Conclusion: Factors for recurrence of laryngeal carcinoma are complex. The expression of c- Myc, survivin and PTEN is related to postoperative recurrence of laryngeal cancer, which may be used as an indicator of postoperative recurrence of laryngeal cancer.