甲状腺髓样癌中主要组织相容性复合体Ⅱ的表达及其意义

Expression and clinical significance of MHCⅡin medullary thyroid carcinoma

目的探讨主要组织相容性复合体(major histocompatibility complex,MHC)Ⅱ类分子在甲状腺髓样癌(medullary thyroid carcinoma,MTC)中的表达情况及其临床意义。方法收集2010年1月至2018年12月在天津医科大学肿瘤医院甲状腺颈部肿瘤科接受治疗的98例甲状腺髓样癌患者的临床病理资料,所有手术标本均经病理确诊为甲状腺髓样癌。通过免疫组织化学染色检测了MHCⅡ类分子在MTC中的表达,并分析其表达水平与临床病理特征及预后相关性。结果MHCⅡ类分子高表达与患者年龄(χ^2=0.900,P=0.410)、多灶性(χ^2=0.295,P=0.672)、双侧病灶(χ^2=2.957,P=0.127)、T分期(χ^2=0.554,P=0.457)无关,而与性别(χ^2=5.227,P=0.025)、术前降钙素水平(χ^2=6.663,P=0.019)、淋巴结转移(χ^2=21.651,P<0.001)及AJCC分期(χ^2=19.522,P<0.001)相关。MHCⅡ类分子高表达患者总体生存率97.4%,高于低表达患者的66.1%(P=0.0163)。COX回归模型进行多因素分析发现,年龄>55岁(HR=4.129,P=0.009)、T分期(HR=3.265,P=0.024)为MTC患者预后的独立危险因素;MHCⅡ类分子高表达(HR=0.103,P=0.030)为MTC患者预后的保护性因素。结论MTC患者中存在MHCⅡ类分子的表达,表达水平高的患者预后较好。

Objective To examine the expression of MHC classⅡin medullary thyroid carcinoma(MTC)and analyze its clinical significance.Methods 98 MTC patients treated at Tumor Hospital of Tianjin Medical University from Jan 2010 to Dec 2018 were included for the study.Immunohistochemistry was used to detect the expression of MHC classⅡmolecule.Results The high expression of MHC classⅡwas not correlated with age(χ^2=0.900,P=0.410),multifocal(χ^2=0.295,P=0.672),bilateral(χ^2=2.957,P=0.127),T stage(χ^2=0.554,P=0.457),but correlated with gender(χ^2=5.227,P=0.025),preoperative calcitonin level(χ^2=6.663,P=0.019),lymph node metastasis(χ^2=21.651,P<0.001)and AJCC stage(χ^2=19.522,P<0.001).Overall survival rate of patients with high expression of MHC classⅡwas 97.4%.It was significantly higher than that of patients with low expression 66.1%(P=0.0163).COX regression model showed that age>55 years old(HR=4.129,P=0.009),T stage(HR=3.265,P=0.024)were independent risk factors for the prognosis of MTC patients.High expression of MHC classⅡmolecules(HR=0.103,P=0.030)was a protective factor for the prognosis of MTC patients.Conclusion The MTC patients with high expression of MHC classⅡhave a better prognosis.