CK20、P53、Ki67蛋白联合影像学特征与结肠癌分化程度及预后的关系

Relationship between the combined imaging features of CK20,P53 and Ki67 proteins and the degree of differentiation and prognosis of colon cancer

目的探讨细胞角蛋白20(CK20)、肿瘤抑制基因(p53)、细胞增殖核抗原Ki67(Ki67)联合影像学特征与结肠癌分化程度及预后的关系。方法以2017年1月至2021年6月首都医科大学附属北京友谊医院平谷医院收治的125例结肠癌患者为研究对象,均有保存切除的肿瘤组织,并按分化程度分为低分化组(n=41)、中分化组(n=51)、高分化组(n=33)。检测患者肿瘤组织中的CK20、P53、Ki67蛋白表达,CT记录结肠癌患者的影像学特征,比较不同分化程度患者肿瘤组织中的CK20、P53、Ki67蛋白表达及影像学特征。所有患者随访1年,并按预后情况分为预后良好组(n=107)及预后不良组(n=18),比较不同预后患者的CK20、P53、Ki67蛋白表达及影像学特征,ROC分析患者CK20、P53、Ki67蛋白对结肠癌患者不良预后的预测价值。结果不同分化程度组的CK20、P53、Ki67蛋白表达比较,低分组的CK20、P53、Ki67阳性蛋白表达均高于中、高分化组(χ^(2)=9.055,9.543,12.239,P<0.05);低分组的肠壁增厚程度、受累肠管长度、淋巴结数目及CT值均高于中、高分化组,差异有统计学意义(χ^(2)=7.571,6.493,F=24.101,22.491,6.373,P<0.05)。多因素Logistic回归分析显示,CK20、P53、Ki67阳性蛋白表达及影像学特征(肠壁增厚程度、受累肠管长度、淋巴结总数、最大淋巴结的短径及CT值)均是结肠癌患者预后的独立危险因素(P<0.05)。ROC曲线显示,CK20、P53、Ki67蛋白及三者联合检测曲线下面积为0.731、0.821、0.854、0.931。结论结肠癌患者肿瘤组织中CK20、P53、Ki67蛋白及影像学特征与患者的分化程度和预后有关,CK20、P53、Ki67蛋白联合检测对患者预后有较高的预测价值。

Objective To investigate the relationship between cytokeratin 20(CK20),tumor sup⁃pressor gene(p53),and cell proliferation nuclear antigen Ki67(Ki67)combined with imaging features and the degree of differentiation and prognosis of colon cancer.Methods One hundred and twenty⁃five colon can⁃cer patients admitted to Beijing Friendship Hospital Pinggu Hospital of Capital Medical University from Janu⁃ary 2017 to June 2021,all of whom had preserved resected tumor tissues,were selected and divided into the low differentiation group(n=41),the medium differentiation group(n=51),and the high differentiation group(n=33)according to the degree of differentiation.Western blot was used to detect the protein expression of CK20,P53 and Ki67 in patients’tumor tissues,and CT was used to record the imaging characteristics of pa⁃tients with colon cancer,and to compare the protein expression of CK20,P53 and Ki67 and imaging character⁃istics in tumor tissues of patients with different degrees of differentiation.All patients were followed up for 1 year and divided into the good prognosis group(n=107)and the poor prognosis group(n=18)according to their prognosis.CK20,P53,Ki67 protein expression and imaging characteristics of patients with different prognosis were compared,and the predictive value of CK20,P53,Ki67 protein on poor prognosis of colon cancer patients was analyzed by the ROC.Results The protein expression of CK20,P53 and Ki67 in the dif⁃ferent differentiation degree groups were compared,and the positive protein expression of CK20,P53 and Ki67 in the low subgroups were higher than those in the middle and high differentiation groups(χ^(2)=9.055,9.543,12.239,P<0.05).The degree of intestinal wall thickening,length of involved intestinal canal,number of lymph nodes and CT values were higher in the low group than those in the medium and high differentiation groups,and the difference was statistically significant(χ^(2)=7.571,6.493,F=24.101,22.491,6.373,P<0.05).Multi⁃factor logistic regression analysis showed that CK20,P53,Ki67 positive protein expression and imaging features(degree of intestinal wall thickening,length of involved intestinal canal,total number of lymph nodes,short diameter of the largest lymph node and CT value)were independent risk factors for the prognosis of patients with colon cancer(P<0.05).The ROC curves showed that the areas under the curves of CK20,P53,Ki67 protein and the combined detection of the three were 0.731,0.821,0.854,0.931.Conclusion The CK20,P53,Ki67 proteins and imaging features in tumor tissues of colon cancer patients are related to the dif⁃ferentiation degree and prognosis of patients,and the combined detection of CK20,P53 and Ki67 proteins has a high predictive value for patients’prognosis.