细胞角蛋白在牙龈鳞癌颈淋巴结中的表达及临床意义

发布时间：2018-06-24 12:12

  本文选题：牙龈鳞癌 + 细胞角蛋白　； 参考：《青岛大学》2014年硕士论文

【摘要】：目的：研究细胞角蛋白(CK-AE1/AE3)在牙龈鳞状细胞癌颈淋巴结中的表达及临床意义。 方法：选取2008年5月到2013年10月间青岛大学附属医院口腔颌面外科病房收治的52例牙龈鳞癌病例,共计845枚淋巴结。将845枚淋巴结根据常规HE染色结果分为病理转移组(pN+,167枚淋巴结)组和病理未转移组(pN0,678枚淋巴结),其中pN+组根据阳性淋巴结所在颈部分区分为阳性淋巴结区组(A组,28枚阳性淋巴结与44枚阴性淋巴结)和阴性淋巴结区组(B组,95枚淋巴结)。将上述各组淋巴结应用广谱细胞角蛋白单克隆抗体(CK-AE1/AE3)作为免疫标志物,采用SABC法行免疫组织化学检测抗体的表达。HE染色与CK免疫组化染色两种检测方法结果应用统计学软件SPSS18.0进行处理,并按以上结果将患者重新行TNM分期,结果行卡方检验。 结果：pN+组：A组HE染色阳性表现的28枚淋巴结中,经CK免疫组化染色均呈阳性表达；HE染色阴性表现的44枚淋巴结中,经CK免疫组化染色后新发现5枚淋巴结呈阳性表达,新增阳性表达为11.36%(5/44)。B组HE染色阴性表现的95枚淋巴结中,经CK免疫组化染色后,新发现6枚淋巴结呈阳性表达,新增阳性表达率为6.31%(6/95)。pN0组：678枚HE染色阴性表现的淋巴结经CK免疫组化染色后,4枚淋巴结呈阳性表达,阳性率为0.59%(4/678)。HE染色结果与CK免疫组织化学染色结果经统计学卡方检验,差异有统计学意义(χ2=540.130,p0.01)。CK免疫组化新发现的15枚阳性淋巴结分别发生于12例患者中,导致5例患者TNM分期发生了变化。2例患者的3枚淋巴结出现“跳跃转移”,其中2枚淋巴结跳过Level Ⅰ直接转移至Level Ⅱ,1枚淋巴结跳过Level Ⅰ、Level Ⅱ直接转移至Level Ⅲ。跳跃转移淋巴结均由CK免疫组化染色发现,且均发生在HE染色阴性(pN0组)的患者。 结论：采用CK (AE1/AE3)作为免疫标志物的免疫组化法检测牙龈鳞状细胞癌的淋巴结,较传统HE染色法更为敏感；CK免疫组化检查可以更准确的确定TNM分期,从而为牙龈癌的治疗及预后判断提供依据；CK免疫组化染色在“跳跃转移”的诊断中具有重要价值。
[Abstract]:Objective: to study the expression and clinical significance of cytokeratin (CK-AE1 / AE3) in cervical lymph nodes of gingival squamous cell carcinoma (GSCC). Methods: 52 cases of gingival squamous cell carcinoma (GSCC) were selected from the oral and maxillofacial surgery ward of Qingdao University affiliated Hospital from May 2008 to October 2013. A total of 845 lymph nodes were selected. According to the results of routine HE staining, 845 lymph nodes were divided into pathological metastasis group (pN167 lymph nodes) and pathological non-metastatic group (pN0678 lymph nodes). Among them, PN group was divided into positive lymph nodes group (A) according to the cervical division of positive lymph nodes. There were 28 positive and 44 negative lymph nodes and 95 negative lymph nodes in group B. The lymph nodes in the above groups were treated with broad spectrum cytokeratin monoclonal antibody (CK-AE1 / AE3) as immune markers. SABC method was used to detect the expression of antibody. He staining and CK immunohistochemical staining were used to process the results with SPSS 18.0. According to the above results, TNM staging was performed again, and chi-square test was performed. Results out of 28 lymph nodes in group 1: pN, 44 lymph nodes were positive for HE staining by immunohistochemical staining of CK, and 5 lymph nodes were found positive by immunohistochemical staining of CK. The new positive expression was 11.36% (5 / 44). Among 95 lymph nodes with negative HE staining, 6 lymph nodes were found to be positive after CK immunohistochemical staining. The new positive expression rate was 6.31% (6 / 95). PN0 group showed positive expression of 4 lymph nodes in the negative lymph nodes with HE staining. The positive rate was 0.59% (4 / 678). The results of HE staining and immunohistochemical staining of CK were statistically chi-square test. The difference was statistically significant (蠂 ~ 2 ~ 2 ~ (540.130) / p ~ (0.01). The newly discovered 15 positive lymph nodes of CK were found in 12 cases, which resulted in the change of TNM staging in 5 cases and the "jump metastasis" of 3 lymph nodes in 2 cases. Among them, 2 lymph nodes skipped level 鈪，

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