ATRX、P53表达的相关性及联合多因素对胶质瘤预后的意义

Correlation of ATRX and P53 expression and prognostic significance of combination of multiple factors in glioma

目的探讨脑胶质瘤患者中ATRX失表达与P53过表达的相关性,并分析二者与临床多因素在胶质瘤诊断及预后中的意义。方法收集2014年1月—2020年12月徐州医科大学附属医院神经外科收治的术后病理诊断为胶质瘤的患者92例,其中包括星形细胞瘤(WHOⅡ、Ⅲ级)30例、少突胶质细胞瘤(WHOⅡ、Ⅲ级)50例、胶质母细胞瘤(WHOⅣ级)12例,并使用免疫组织化学染色法检测ATRX与P53表达情况,并统计不同年龄、性别与二者间的关系;χ~2检验分析ATRX失表达、P53过表达与不同病理类型脑胶质瘤的关系且二者表达之间的关系用Spearman等级相关分析法检验;Kaplan-Meier生存曲线分析二者对胶质瘤患者预后的影响,其他临床因素纳入多因素Cox回归分析。结果ATRX与P53表达与胶质瘤病理类型相关(P<0.05);相关性分析显示,胶质瘤中ATRX与P53表达呈负相关(r=-0.580,P<0.01);多因素分析表明,胶质瘤患者的年龄≥60岁、病理分级WHOⅢ-Ⅳ级、术前KPS评分<60分、术后无放化疗、肿瘤直径≥5 cm、肿瘤非全切、ATRX失表达、P53过表达是预后不良的独立危险因素(P<0.05)。结论在人脑胶质瘤患者中,ATRX失表达与P53过表达密切相关,与临床其他多因素联合可更好地对胶质瘤患者的预后进行评估。

Objective To explore the correlation between the loss of expression of alpha thalassemia with mental retardation syndrome gene(ATRX)and over expression of P53 in patients with glioma and to analyze the clinical significance of the two gene expression and multi-factors in the diagnosis and prognosis of glioma.Method The clinical data of 92 patients were collected,including 30 patients with astrocytoma of gradeⅡ/Ⅲ(WHO),50 with oligodendroglioma of gradeⅡ/Ⅲ(WHO)and 12 with glioblastoma of gradeⅣ(WHO).The Chi-square test was applied to analyze the relationship between the two gene expression and different pathological types of glioma.The Spearman s rank correlation analysis was used to analyze the correlation between their different expression.Kaplan-Meier survival curve was designed to investigate the clinical value of their different expression in prognosis of patients with glioma.The other contributing factors were analyzed in the multivariate Cox regression analysis.Results There was a correlation between the different expression of ATRX and P53 and the pathological types of glioma(P<0.05).The correlation analysis showed that the loss of expression of ATRX and over expression of P53 in glioma were negative correlated(r=0.426,P<0.01).The multivariate analysis showed that the age over 60 years old,gradeⅢ/Ⅳ(WHO),preoperative KPS scores below 60 points,lack of postoperative radiotherapy and chemotherapy,and lost expression of the ATRX were independently risk factors for poor prognosis.Conclusion In patients with glioma,the loss of expression of ATRX and over expression of P53 were closely related to one another,and they together with other clinical factors can better evaluate the prognosis of glioma patients.