Ki-67、突变型p53表达和CT与直肠腺癌亚型、病理分化程度的相关性及临床价值分析

Correlation and clinical value analysis of Ki-67,mutant p53 expression and CT with rectal adenocarcinoma subtype and degree of pathological differentiation

目的探究核基因Ki-67、突变型p53表达和CT与直肠腺癌亚型、病理分化程度的相关性及临床价值。方法选取2021年1月~2022年12月启东市人民医院收治的直肠腺癌患者90例,采用免疫组织化学法对患者的Ki-67及突变型p53表达情况进行测定,并对患者进行CT影像检查。探究患者Ki-67及突变型p53表达情况及CT检查结果与直肠腺癌亚型、病理分化程度的相关性,并采用受试者工作特征曲线(ROC)探究各指标对患者直肠腺癌高度分化的诊断价值。结果根据患者直肠腺癌亚型将90例患者分为A组(n=73,管状腺癌)和B组(n=17,黏液腺癌);根据患者的分化程度将患者分为C组(n=74,低分化)及D组(n=16,中分化及高分化)。Ki-67在A、B组中的阳性率分别为76.71%、47.06%,C、D组中的阳性率分别为47.30%、87.50%,差异有统计学意义(χ^(2)=4.547、8.573,P<0.05);突变型p53在A、B组中的阳性率分别为53.42%、23.53%,在C、D组中的阳性率分别为36.49%、81.25%,差异有统计学意义(χ^(2)=4.939、10.676,P<0.05)。C、D组间肿瘤位置、肿瘤肠壁长度、厚度、强化程度、增强后低密度区比较差异无统计学意义(P>0.05);但与C组相比较,D组肠壁偏向性、环形增厚占比、重度肠周浸润占比较大,差异有统计学意义(P<0.05)。Ki-67、突变型p53的阳性表达情况及肠壁偏向性环形增厚和重度肠周浸润对直肠腺癌管状腺癌高分化的ROC曲线下面积分别为0.701、0.724、0.636、0.639,但肠壁偏向性环形增厚和重度肠周浸润诊断差异无统计学意义(P>0.05)。结论Ki-67及突变型p53的阳性表达情况对直肠腺癌亚型和病理分化程度具有一定诊断意义,CT影像特征可以在一定程度上反映直肠腺癌患者病理分化程度,但诊断价值较低。

Objective To explore the correlation and clinical value of nuclear gene Ki-67,mutant p53 expression and CT with rectal adenocarcinoma subtype and pathological differentiation degree.Methods 90 patients with rectal adenocarcinoma admitted to our hospital from January 2021 to December 2022.The expression of Ki-67 and mutant p53 was determined by immunohistochemical method,and the patients were analyzed to explore the expression of Ki-67 and mutant p53 and the correlation between the CT result and the subject(ROC)curve to explore the diagnostic value of the indicators for highly differentiated rectal adenocarcinoma.Results According to the rectal adenocarcinoma subtype,90 patients were divided into group A(n=73,tubular adenocarcinoma)and group B(n=17,mucinous adenocarcinoma),and the patients were divided into group C(n=74,poorly differentiated)and group D(n=16,moderately and highly differentiated).The positive rates of Ki-67 were 76.71%and 47.06%in A and B,47.30%and 87.50%,respectively(χ^(2)=4.547,8.573,P<0.05).The positive rates of mutant p53 were 53 in A,42%and 23.53%,respectively,and 36.49%and 81.25%in C and D,respectively(χ^(2)=4.939,10.676,P<0.05).By physicians of CT imaging result between group C and D,tumor location,wall length,thickness,strengthening degree,enhanced low density area were not statistically significant(P>0.05),but compared with group C,group D wall bias,ring thickening,severe intestinal infiltration was large,and the difference was statistically significant(P<0.05).According to the above result,the ROC area under the positive expression of Ki-67 and mutant p53 and the ROC curve were 0.701,0.724,0.636,0.639,respectively,but the diagnosis of the intestinal wall-biased circular thickening and severe perienteral invasion was not statistically significant(P>0.05).Conclusion The positive expression of Ki-67 and mutant p53 has some diagnostic significance for the subtype and pathological differentiation of rectal adenocarcinoma,and the CT influence feature can reflect the degree of pathological differentiation of rectal adenocarcinoma patients to some extent,but the diagnostic value is low.