VEGF-C，Ki67，nm23-H1在鼻咽癌原发灶中的表达及其与预后关系的研究

发布时间：2018-06-14 16:48

本文选题：VEGF-C + Ki67　；参考：《安徽医科大学》2011年硕士论文

【摘要】：背景与目的:鼻咽癌(nasopharyngeal carcinoma,NPC)的预后与许多因素有关,颈部淋巴结有无转移对鼻咽癌的预后有很大的影响。VEGF-C,Ki67,nm23-H1的表达对鼻咽癌颈部淋巴结转移的作用国内外很少见报道。本研究拟通过检测VEGF-C,Ki67,nm23-H1在鼻咽癌中的表达并分析其与不同临床病理特征、预后的关系,探讨三者在鼻咽癌颈部淋巴结转移发生过程中的作用及相关性。方法:选择2001年8月至2006年12月在安徽省立医院耳鼻咽喉科活检的鼻咽癌组织存档石蜡标本44例,男29例,女15例,男:女=1.93:1;年龄26-81岁,中位年龄55岁。采用免疫组化SP法检测标本中肿瘤组织VEGF-C,Ki67,nm23-H1蛋白的阳性表达率,并对全部病例进行随访。数据采用SPSS13.0软件进行统计分析,VEGF-C,Ki67,nm23-H1蛋白表达组间差异比较采用χ2检验;预后的单因素分析采用Kaplan-meier曲线,组间比较应用log-rank检验;预后的多因素分析采用Cox比例风险模型;相关分析采用spearman等级相关分析方法。P0.05为差异有统计学意义。结果: VEGF-C、Ki67、nm23-H1在NPC组织中的阳性表达率分别为72.7%、77.3%、45.5%。VEGF-C、Ki67、nm23-H1的阳性表达率均与T分期、临床分期、KPS评分、是否贫血等均无关(P0.05),而与年龄、N分期、首程治疗是否达到CR、生存时间是否大于5年有显著相关性(P0.05)。VEGF-C与Ki67呈正相关性(r=0.97,P=0.000),与nm23-H1负相关(r=-0.66,P=0.016),Ki67与nm23-H1无相关性(P=0.074)。VEGF-C和Ki67在颈淋巴结阳性组的表达率明显高于颈淋巴结阴性组(P0.05),而nm23-H1则相反,且有统计学差异。全组病例死亡25例,生存19例,中位生存时间46.5个月(生存时间8—98个月),3年、5年生存率分别为65.9%、43.2%。单因素分析显示:性别、年龄、治疗前KPS评分、T分期、N分期、临床分期、首程治疗后是否完全缓解、VEGF-C、Ki67及nm23-H1等11个因素对鼻咽癌生存有影响(P0.05),多因素回归分析表明,N分期、首程治疗后是否完全缓解、VEGF-C是鼻咽癌患者独立的预后因素(P0.05)。结论: 1、VEGF-C和Ki67在颈部淋巴结阳性的患者中的表达高于无淋巴结转移者,两者呈正相关,提示两者可能对颈部淋巴结转移起了正协同作用,并且显著影响了患者远期生存率,是预后的不良因素。Ki67和nm23-H1高表达患者的首程CR率明显高于低表达患者,VEGF-C在鼻咽癌组织中的表达则相反,显示NPC组织中Ki67、nm23-H1高表达、VEGF-C低表达的患者对放疗更加敏感。 2、nm23-H1在颈部淋巴结阳性患者表达率小于无颈部淋巴结转移患者,且nm23-H1高表达的5年生存率明显高于低表达患者,是较好的预后因素。 3、N分期、首程治疗后是否完全缓解、VEGF-C是鼻咽癌患者独立的预后因素。包括性别、年龄、治疗前KPS评分、T分期、临床分期、Ki67及nm23-H1,可作为预测鼻咽癌临床疗效和判断预后的参考指标。
[Abstract]:Background & objective: the prognosis of nasopharyngeal carcinoma NPCs is related to many factors. The effect of VEGF-Cnm23-H1 expression on the cervical lymph node metastasis of nasopharyngeal carcinoma is rarely reported at home and abroad. The purpose of this study was to investigate the expression of VEGF-Cnm23-H1 in nasopharyngeal carcinoma (NPC) and its relationship with different clinicopathological features and prognosis, and to explore the role and correlation of VEGF-Cnm23-H1 in cervical lymph node metastasis of nasopharyngeal carcinoma (NPC). Methods: from August 2001 to December 2006, 44 paraffin specimens of nasopharyngeal carcinoma (29 males and 15 females), aged 26-81 years, with median age of 55 years, were selected from the Department of Otorhinolaryngology of Anhui Provincial Hospital. Immunohistochemical SP method was used to detect the positive expression rate of VEGF-Cnm23-H1 protein in tumor tissue, and all cases were followed up. Statistical analysis was carried out by SPSS 13.0 software and 蠂 2 test was used to compare the difference of expression of VEGF-Cnm23-H1 protein, Kaplan-meier curve and log-rank test were used for univariate analysis of prognosis, Cox proportional risk model was used for multivariate analysis of prognosis. Correlation analysis using spearman grade correlation analysis method. P05 as the difference was statistically significant. Results: the positive expression rates of VEGF-Cnm23-H1 in NPC tissues were 72.7and 77.3nm23-H1, respectively. The positive expression rates of VEGF-Cnm23-H1 were correlated with T stage, clinical stage, KPS score, anemia, etc. Whether the survival time of the first course of treatment is more than 5 years is significantly higher than that of the patients with nm23-H1. The positive correlation between VEGF-C and Ki67 is significant. The positive expression rate of VEGF-C and Ki67 is significantly higher than that of nm23-H1 negative correlation with nm23-H1. There is no correlation between nm23-H1 and nm23-H1. The expression rate of VEGF-C and Ki67 in cervical lymph nodes is significantly higher than that in nm23-H1 positive patients with nm23-H1. The positive rate of VEGF-C and Ki67 is significantly higher than that of nm23-H1. In sex group, P0.05, nm23-H1 was the opposite. And there is statistical difference. 25 cases died, 19 cases survived, the median survival time was 46.5 months (survival time 8-98 months), the 3-year and 5-year survival rates were 65.9% and 43.23.2respectively. Univariate analysis showed that sex, age, KPS score, T stage and N stage before treatment, clinical stage, complete remission of VEGF-CU Ki67 and nm23-H1 after first course of treatment had influence on the survival of nasopharyngeal carcinoma (NPC) (P 0.05). Complete remission of VEGF-C is an independent prognostic factor in nasopharyngeal carcinoma (NPC) patients after the first course of treatment (P 0.05). Conclusion: 1 the expression of VEGF-C and Ki67 in the patients with cervical lymph node positive was higher than that in the patients without lymph node metastasis, and the positive correlation was found between the two groups, which suggested that the expression of VEGF-C and Ki67 might play a positive synergistic role in cervical lymph node metastasis. The first stage CR rate of patients with high expression of Ki67 and nm23-H1 was significantly higher than that of patients with low expression of VEGF-C in nasopharyngeal carcinoma. The results showed that the patients with high expression of Ki67nm23-H1 and low expression of VEGF-C were more sensitive to radiotherapy. 2the positive expression rate of nm23-H1 in cervical lymph nodes was lower than that in patients without cervical lymph node metastasis, and the 5-year survival rate of patients with high expression of nm23-H1 was significantly higher than that of patients with low expression. 3N stage and complete remission after first treatment were independent prognostic factors for nasopharyngeal carcinoma. It includes sex, age, KPS score and T stage before treatment, clinical staging, Ki67 and nm23-H1, which can be used as a reference index to predict the clinical efficacy and prognosis of nasopharyngeal carcinoma.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R739.63

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