食管鳞癌患者Podoplanin和Twist表达情况及其与临床预后的研究

发布时间：2018-03-13 22:20

本文选题：食管鳞癌　切入点：脉管瘤栓　出处：《四川医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:食管鳞癌患者脉管内瘤栓对食管鳞癌患者的影响患者已受到越来越多学者的关注和研究。食管鳞癌患者脉管内出现瘤栓这一病理现象的出现可能主要与肿瘤自身所具有的侵袭性和转移性两种特性有关。现有的研究结果已经证实Podoplanin和Twist有介导肿瘤发生和增强肿瘤转移和侵袭的作用,在肿瘤的侵袭和转移过程中发挥了十分重要的影响。本实验将观察Podoplanin和Twist在食管鳞癌患者中的表达情况,分析这两种蛋白阳性表达与食管鳞癌患者脉管内出现瘤栓的关系,并进一步分析其表达与淋巴结转移、肿瘤分化等临床特征以及患者预后之间的关系,探究可能影响食管鳞癌患者的危险因素,为临床上对于这类患者的治疗提供参考依据,以期尽可能减少肿瘤的复发,延长食管鳞癌患者的无病生存时间以及总生存时间。方法对四川省肿瘤医院胸外科一病区在2010年6月至2012年6月间有完整临床病理资料和随访记录的70例食管鳞癌患者(脉管瘤栓阳性食管鳞癌患者35例,脉管瘤栓阴性食管鳞癌患者35例)的术后病理标本进行免疫组化,SP染色。显微镜下分别观察Podoplanin、Twist两种蛋白在不同的部位,即肿瘤组织和脉管瘤栓中的表达,并选择同期70例患者的正常食管组织进行对照比较,分析1、两种蛋白在肿瘤组织与正常组织间是否存在差异;2、这两种蛋白在肿瘤细胞中的表达与患者脉管内出现瘤栓之间的关系,并进一步分析其表达与患者年龄、性别、肿瘤浸润深度(t分期)、肿瘤分化程度、淋巴结转移这些临床病理特征之间的关系;3、两种蛋白在肿瘤细胞和脉管瘤栓的表达是否一致;4、两种蛋白在血管瘤栓和淋巴管瘤栓中的表达是否有选择性。5、肿瘤复发(即无病生存期)与这两种蛋白表达、脉管内出现瘤栓、淋巴结转移等这些危险因素之间的联系。结果:正常食管组织中podoplanin阳性表达率为34.2%,肿瘤组织podoplanin阳性表达率为62.8%,两组差异性明显(p0.05);正常组织中twist阳性表达率为42.9%,肿瘤组织中twist阳性表达率为77.1%,两组同样差异性显著(p0.05)。脉管瘤栓阳性食管鳞癌患者肿瘤细胞内podoplanin阳性率77.1%,脉管瘤栓阴性食管鳞癌患者肿瘤细胞内podoplanin阳性率48.6%,差异具有统计学意义(p0.05)。淋巴结转移阳性的食管鳞癌患者肿瘤细胞内podoplanin阳性率71.9%,淋巴结转移阴性的食管鳞癌患者肿瘤细胞内podoplanin阳性率23.1%,差异具有统计学意义(p0.05)。肿瘤细胞内podoplanin阴性的食管鳞癌患者平均无病生存期15.2月,显著优于肿瘤细胞内podoplanin阳性的食管鳞癌患者(p0.05)。食管鳞癌患者年龄、性别、肿瘤浸润深度、肿瘤分化程度与podoplanin在肿瘤细胞中的表达之间不存在相关性(p0.05);脉管瘤栓阳性食管鳞癌患者肿瘤细胞内twist表达率74.3%,脉管瘤栓阴性食管鳞癌患者肿瘤细胞内twist表达率80%,两组间twist的表达差异不具有统计学意义(p0.05);食管鳞癌患者肿瘤细胞内twist阴性表达组平均无病生存期8.3月,与食管鳞癌患者肿瘤细胞内twist阳性表达组之间无显著差异(p0.05);食管鳞癌患者年龄、性别、肿瘤浸润深度、肿瘤分化程度、淋巴结转移与Twist在肿瘤细胞内阳性表达不存在相关性(P0.05);Podoplanin在肿瘤细胞的阳性表达率和在脉管瘤栓内阳性表达率分别为77.1%和65.7%,无显著差异(P0.05)。Twist在肿瘤细胞阳性表达率和在脉管瘤栓内阳性表达率分别为74.3%和71.4%,其差异无统计学意义(P0.05);Podoplanin在脉管瘤栓阳性患者的淋巴管和血管内表达分别为78.3%和69.6%,Twist在脉管瘤栓阳性患者的淋巴管和血管内表达分别为56%和72%,均无显著差异(P0.05)。结论:1、Podoplanin和Twist在肿瘤组织中阳性表达率显著较正常组织高。2、脉管瘤栓阳性的食管鳞癌患者和淋巴结转移阳性的食管鳞癌患者肿瘤细胞内Podoplanin阳性表达率明显较高,说明Podoplanin在肿瘤细胞内阳性表达与食管鳞癌患者出现脉管瘤栓和淋巴结发生转移存在相关性;Podoplanin在肿瘤细胞内的阳性表达与食管鳞癌患者年龄、性别、肿瘤浸润深度、肿瘤分化程度之间不存在相关性;食管鳞癌患者肿瘤细胞内Podoplanin阳性表达组无病生存期明显较阴性表达组短。临床上可将Podoplanin的阳性表达作为判断食管鳞癌患者预后的重要参考指标。3、本实验中Twist在肿瘤细胞内的表达与食管鳞癌患者的临床病理特征和无病生存期之间无明显相关性4、Podoplanin和Twist在肿瘤细胞内和脉管瘤栓内的表达率具有一致性,在血管瘤栓和淋巴管瘤栓内的表达无选择性,提示Podoplanin阳性表达率高的患者肿瘤侵袭性较强。
[Abstract]:Objective: it has been more and more attention of scholars and research vessel in patients with esophageal squamous cell carcinoma tumor thrombus of patients with esophageal squamous cell carcinoma patients. The emergence of the pathological phenomenon of vascular tumor thrombus in patients with esophageal squamous cell carcinoma within the tumor may be related to themselves with the invasive and metastatic characteristics of two kinds of the existing research results have been confirmed. Podoplanin and Twist mediated tumor metastasis and invasion of tumor and enhance the role played a very important effect in the process of tumor invasion and metastasis. This study was to investigate the expression of Podoplanin and Twist in esophageal squamous cell carcinoma, analysis of the relationship between the two kinds of tumor thrombus in patients with esophageal squamous cell carcinoma and the expression of vascular within, and further analysis of its expression and lymph node metastasis, tumor differentiation and the relationship between the clinical characteristics and prognosis of patients with esophageal squamous cell carcinoma patients, exploring the possible influence The risk factors, and to provide reference for the clinical treatment of these patients, in order to reduce tumor recurrence and prolong disease-free survival time of patients with esophageal squamous cell carcinoma and overall survival time. Methods the Department of thoracic surgery, Tumor Hospital of Sichuan Province in a complete clinical and pathological data and follow-up records from June 2010 to June 2012. 70 cases of patients with esophageal squamous cell carcinoma (Lvsi positive patients with esophageal squamous cell carcinoma in 35 cases, 35 cases of Lvsi negative patients with esophageal squamous cell carcinoma) postoperative pathological specimens by immunohistochemistry, SP staining were observed under microscope. Podoplanin and Twist two proteins in different parts, namely the expression of tumor tissue and tumor thrombus in during the same period, and in normal esophageal tissues of 70 patients were compared, analysis of 1, whether in the tumor tissues and normal tissues there were differences between the two proteins; 2 of the two proteins in tumor cells The relationship between the expression of tumor thrombus in patients with vascular, and further analysis of the expression of gender and age, and the depth of tumor invasion (T staging), tumor differentiation, lymph node metastasis, the relationship between these clinicopathological features; 3, two proteins in tumor cells and vascular invasion are consistent; 4, two kinds of protein in vascular tumor thrombus and expression of lymphatic tumor emboli in whether selective.5, tumor recurrence (i.e. disease-free survival) and the expression of the two proteins, tumor thrombus appeared in the vasculature, between the lymph node metastasis of these risk factors. Results: the positive expression rate of Podoplanin was 34.2% in normal esophageal tissues, the positive expression of Podoplanin in tumor tissues was 62.8%, significantly differences between the two groups (P0.05); the positive expression rate of twist was 42.9% in normal tissue, the positive expression rate of twist was 77.1% in tumor tissue, the two group also have significant difference (P0.05) pulse. Vessel tumor embolus in patients with esophageal squamous cell carcinoma cells Podoplanin positive rate of 77.1%, Lvsi negative patients with esophageal squamous cell carcinoma cells in the Podoplanin positive rate was 48.6%, the difference was statistically significant (P0.05). The lymph node metastasis of tumor in patients with esophageal squamous cell carcinoma cells in the Podoplanin positive rate was 71.9%, the tumor lymph node negative metastasis in patients with esophageal squamous cell carcinoma cells the positive rate of Podoplanin was 23.1%, the difference was statistically significant (P0.05). The tumor cells in Podoplanin negative patients with esophageal squamous cell carcinoma average disease-free survival was 15.2 months, patients with esophageal squamous cell carcinoma was significantly higher than that of tumor cells in Podoplanin positive (P0.05) in patients with esophageal squamous cell carcinoma. Age, gender, tumor invasion depth, there is no correlation between the expression of tumor the degree of differentiation and Podoplanin in tumor cells (P0.05); the expression rate of twist was 74.3% in Lvsi positive patients with esophageal squamous cell carcinoma cells, The expression rate of 80% twist Lvsi negative patients with esophageal squamous cell carcinoma cells, differential expression of twist between the two groups was not statistically significant (P0.05); patients with esophageal squamous cell carcinoma cells in twist negative expression group average disease-free survival was 8.3 months, with no significant difference between tumor cells in patients with esophageal squamous cell carcinoma (twist positive expression group P0.05); age, gender of patients with esophageal squamous cell carcinoma, tumor invasion, tumor differentiation, lymph node metastasis and the expression of Twist in tumor cells (P0.05); there is no correlation between the positive expression of Podoplanin in tumor cell rate and tumor thrombus in the vascular in the positive expression rates were 77.1% and 65.7%, no significant difference (P0.05.Twist) and rate of tumor thrombus in the vascular in the positive expression rates were 74.3% and 71.4% positive expression in tumor cells, the difference was not statistically significant (P0.05); Podoplanin in Lvsi positive patients with lymphatic And the intravascular level were 78.3% and 69.6%, Twist in Lvsi positive patients with lymphatic and vascular expression were 56% and 72%, there was no significant difference (P0.05). Conclusion: 1, Podoplanin and Twist in tumor tissues was significantly positive expression rate of.2 was higher than that in normal tissues, tumor thrombus positive in patients with esophageal squamous cell carcinoma and lymph node metastasis was significantly higher in Podoplanin positive expression rate of tumor in patients with esophageal squamous cell carcinoma cells with positive Podoplanin expression in esophageal squamous cell carcinoma and tumor cells in patients with vascular invasion and lymph node metastasis are related; the positive expression of Podoplanin in tumor cell and esophageal squamous cell carcinoma patients with age, sex, tumor the depth of invasion, there was no correlation between the degree of tumor differentiation; the positive expression of patients with esophageal squamous cell carcinoma cells in Podoplanin group was significantly higher than disease-free survival in negative group clinical short. The positive expression of Podoplanin as an important reference index for judging the prognosis of.3 patients with esophageal squamous cell carcinoma, between the clinical and pathological features of the expression of Twist in tumor cell and esophageal squamous cell carcinoma patients and disease free survival was no significant correlation between the 4, the expression of Podoplanin and Twist in tumor cells and tumor thrombus in rate consistency in vascular tumor thrombus and expression of lymphatic tumor thrombus in non selective, suggesting that the positive expression rate of Podoplanin in patients with high tumor invasion is stronger.

【学位授予单位】：四川医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.1

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