前列腺癌组织Survivin和p27表达临床意义研究

Expression of Survivin and p27 in prostate cancer and its clinical significance

目的Survivin和p27在多种肿瘤的临床分期、病理分级以及预后判断中具有重要应用价值。本研究通过检测前列腺癌组织中Survivin和p27表达,及其与临床病理特征的关系,进一步探讨其在预测前列腺癌患者前列腺特异性抗原无进展生存时间(prostate-specific antigen progression-free survival,PSA PFS)中的作用。方法选取2013-01-01-2019-08-01山东省肿瘤医院收治的前列腺癌组织99例和前列腺增生组织27例,采用免疫组化法检测Survivin和p27表达并对患者血清PSA值进行随访,计算患者PSA PFS。结果前列腺癌组织中Survivin阳性率为84.8%(84/99),高于前列腺增生组织的7.4%(2/27),差异有统计学意义,χ^2=58.716,P<0.001;前列腺癌组织中p27阳性率为33.3%(33/99),低于前列腺增生组织的77.8%(21/27),差异有统计学意义,χ^2=17.111,P<0.001。Survivin表达与前列腺癌的局部T分期(χ^2=8.839,P=0.003)、Gleason评分(χ^2=10.925,P=0.004)以及是否发生骨转移(χ^2=8.048,P=0.005)具有关联性;而与患者年龄、初始PSA值是否>100 ng/mL以及最低PSA值是否≤0.1 ng/mL差异无统计学意义,P>0.05;p27表达与Gleason评分(χ^2=9.750,P=0.008)、是否发生骨转移(χ^2=15.240,P<0.001)以及初始PSA值是否>100 ng/mL(χ^2=7.312,P=0.007)有关联性,而与患者年龄、局部T分期以及最低PSA值是否≤0.1 ng/mL差异无统计学意义,P>0.05。Log-rank检验分析发现,是否发生骨转移(P=0.04)、初始PSA值是否>100 ng/mL(P=0.049)、PSA最低值是否≤0.1 ng/mL(P=0.005)、治疗方式(P<0.001)以及p27表达(P=0.005)是影响PSA PFS的相关因素。Cox回归模型分析结果显示,p27表达(HR=0.344,95%CI:0.141~0.840,P=0.005)、治疗方式(HR=0.218,95%CI:0.115~0.413,P<0.001)以及最低PSA值是否≤0.1 ng/mL(HR=0.509,95%CI:0.275~0.943,P=0.032)是PSA PFS的独立保护因素。结论前列腺癌组织中Survivin阳性率较高,p27阳性表达、内分泌+化疗和PSA最低值≤0.1 ng/mL的患者PSA PFS更长。

OBJECTIVE Survivin and p27 have important application value in clinical staging,pathological grading and prognosis of several tumors.In this study,Survivin and p27 expression were dected to analyse the relationship between Survivin and p27 with the general clinical data of prostate cancer patients,and to explore the role of Survivin and p27 in predicting the PSA progression-free survival(PFS)of the patients.METHODS The expressions of Survivin and p27 in 99 samples of prostatic cancer and 27 samples of benign prostatic hyperplasia which acquired from admitted patients in Shandong Cancer Hospital from 2013.01.01 to 2019.08.01 were detected with the immunohistochemical method and also followed up the PSA of allthe patients,finally calculated the PSA PFS.RESULTS Positive rates of Survivin(χ^2=58.716,P<0.001)and p27(χ^2=17.111,P<0.001)in prostatic cancer were 84.8%(84/99)and 33.3%(33/99)respectively,and 7.4%(2/27)and 77.8%(21/27)in samples of benign prostatic hyperplasia respectively;the differences of Survivin(χ^2=58.716,P<0.001)and p27(χ^2=17.111,P<0.001)expression in prostatic cancer and prostatic hyperplasia tissue were statistically significant.Survivin expression was related to the local staging(χ^2=8.839,P=0.003),Gleason score(χ^2=10.925,P=0.004)and metastasis of prostate cancer(χ^2=8.048,P=0.005),and was independent of the age of patients,initial PSA values and the lowest PSA(P>0.05).The relationship between p27 expression and differences in Gleason score(χ^2=9.750,P=0.008),metastasis(χ^2=15.240,P<0.001)and initial PSA values(χ^2=7.312,P=0.007)was statistically significant,while that between p27 expression and the age of patients,local staging and the lowest PSA was insignificant P>0.050.Log-rank test revealed that the presence of bone metastasis(P=0.04),initial PSA of>100 ng/mL(P=0.049),minimum PSA of≤0.1 ng/mL(P=0.005),treatment style(P<0.001),and expression of p27(P=0.005)were the relevant factors influencing the PSA PFS.Cox regression model analysis results showed that p27 expression(HR=0.344,95%CI:0.141-0.840,P=0.005),treatment(HR=0.218,95%CI:0.115-0.413,P<0.001),and whether the minimum PSA value was less than or equal to 0.1 ng/mL(HR=0.509,95%CI:0.275-0.943,P=0.032)were the independent protective factors of PSA PFS.CONCLUSION Survivin and p27 played an important role in the evolution of prostate cancer,patients with p27 expression in prostate cancer tissues have a longer PSA PFS,and the combination of p27 expression and the lowest PSA value can predict the PSA PFS.