喉鳞癌原发灶和切缘p53蛋白表达及其与术后放疗的关系

Effect of p53 expression in the primary lesion and the surgical margin on the postoperative radiotherapy for laryngeal squamous carcinoma

目的 分析喉鳞癌原发灶和病理学阴性切缘中p53蛋白表达与术后放疗的关系。方法回顾性分析 67例喉鳞癌的临床资料 ,采用免疫组化方法检测病理学阴性切缘和原发灶中p53蛋白表达情况。结果 切缘和原发灶中p53阳性率分别为 19.4% (13 / 67)和 50 .7% (3 4 / 67)。在原发灶p53阳性组中 ,与术后未放疗者相比 ,术后放疗者的生存率较未放疗者高 (P =0 .0 0 0 5) ,复发率比较低 (P =0 .0 0 2 ) ;而在原发灶p53阴性组中 ,术后放疗者的生存率、复发率与未放疗者差异无显著性 (P =0 .40 96,P =0 .175)。在切缘p53蛋白阳性组中 ,术后放疗者的生存率和复发率与未放疗者差异无显著性(P =0 .3 781,P =1.0 ) ;在切缘p53蛋白阴性组中 ,术后放疗者的生存率和复发率与未放疗者差异无显著性 (P =0 .0 743 ,P =0 .2 48)。结论 对喉鳞癌原发灶p53蛋白阳性表达者进行术后放疗是有必要的 ,但病理学阴性。

Objective To analyze the correlation between prognosis and p53 expr ession in primary lesion and the surgical margin of laryngeal squamous cell carcinoma (SCC) as an indication of postoperative radiotherapy. Methods Sixty-se ven laryngeal SCC with pathological negative margin were analyzed retrospectivel y. Immunohistochemical method was used to detect the expression of p53. Results The p53 positive rates in the primary tumor and the surgical margin were 19.4% (13/67) and 50.7% (34/67). In p53 positive primary tumor group, the survival rat e was higher in patients who received postoperative radiotherapy than those with out (60.6% vs 20.0%,P=0.000 5) and the recurrent rate was just the reverse (42.1 % vs 93.3%,P=0.002), though these differences were not significant in p53 n egat ive primary tumor group (87.5% vs 94.1%,P=0.409 6; 25.0% vs 5.9%, P =0.175). The recurrent rate and survival rate between patients with and without postoperativ e radiotherapy did not show any significant difference either in p53 positive su rgical margin group (47.4% vs 20.0%, P=0.378 1;62.5% vs 80.0%, P=1 .0) o r p53 negative ones (84.9% vs 66.6%, P=0.074 3 ;20.6% vs 40.7%,P=0. 248). Conclusion Postoperative radiotherapy should be given to patients with p53 positive primary laryngeal cancer. But those who are pathologically margin negative but p53 posi tive should not be taken, at least for the present, as candidates for postoperat ive radiotherapy.