探讨脾切除及相关标志物对贲门癌患者生存率的影响

发布时间：2018-04-27 21:21

本文选题：贲门癌 + 预后　；参考：《吉林大学》2016年博士论文

【摘要】：目的:过去几十年,胃癌的总体发病率逐渐下降,但其中贲门癌的发病率却逐年上升,手术治疗是最常见的治疗方法。为了彻底清除肿瘤细胞及淋巴结,临床手术切除时通常一起切除脾脏,但是脾切除对患者生存率的影响仍存在争议。本研究分析联合脾脏切除术在贲门癌手术治疗中的作用,同时研究贲门癌组织中VEGF、MMP-9和E-cadherin等相关标志物蛋白的表达,探讨联合脾脏切除在外科手术治疗贲门癌中的价值和意义以及VEGF、MMP-9和E-cadherin的表达与贲门癌生物学行为之间的关系,为贲门癌的临床诊断和治疗提供新的思路和理论依据。方法:回顾性分析2003年9月至2010年12月本院收治的348名胃贲门癌患者,其中105名患者进行全胃切除结合脾切除术(脾切除组),243名患者只是进行单纯的全胃切除手术(脾保留组)。分析比较两组患者的术后生存率及预后因素,并采用免疫组化法检测患者贲门癌组织及癌旁组织中的VEGF、MMP-9和Ecadherin蛋白的表达。结果:1、脾切除组患者5年生存率为20.8%,脾保留组患者5年生存率为30.5%,两组相比较差异具有统计学意义。2、多变量分析结果显示,肿瘤浸润深度和淋巴结转移是贲门癌患者的重要预后因素(P0.01),而脾切除不是贲门癌患者的独立预后因素(P=0.206)。3、贲门癌组织中VEGF、MMP-9和E-cadherin蛋白阳性表达率分别为57.31%、60.25%和21.23%,癌旁组织中三个蛋白的表达率分别为11.41%、13.24%和51.74%,三者的表达在癌组织与癌旁组织中均具有统计学差异,P值均小于0.01。4、VEGF、MMP-9和E-cadherin的表达与肿瘤浸润深度和淋巴结转移与否有关。VEGF和MMP-9的表达随着淋巴结转移和肿瘤浸润深度的增加逐渐增强,而E-cadherin的表达则与之相反,随着淋巴结转移和肿瘤浸润深度的增加逐渐降低。5、VEGF、MMP-9和E-cadherin的表达与患者5年生存率相关。VEGF和MMP-9表达越高,患者5年生存率越低(P=0.012,0.015),而E-cadherin表达越高,患者5年生存率越高(P=0.006)。6、线性相关分析表明,VEGF与MMP-9呈正相关(r=1.357,P0.05),与E-cadherin呈负相关(r=-3.241,P0.05,MMP-9与E-cadherin呈负相关(r=-2.563,P0.05)。结论:1、脾切除术不适合所有类型的贲门癌患者,适合浸润深、淋巴结转移多的患者。肿瘤浸润深度和淋巴结转移是贲门癌患者重要预后因素,而脾切除不是贲门癌患者的独立预后因素。2、VEGF、E-cadherin和MMP-9在贲门癌的发生发展和转移过程中起重要作用,三者的异常表达可作为判断患者预后的重要生物学指标。
[Abstract]:Objective: in the past few decades, the overall incidence of gastric cancer has gradually decreased, but the incidence of cardiac cancer has increased year by year. Surgical treatment is the most common treatment. In order to completely remove tumor cells and lymph nodes, splenectomy is usually performed together, but the effect of splenectomy on survival rate remains controversial. The purpose of this study was to investigate the role of combined splenectomy in the surgical treatment of cardiac carcinoma, and to study the expression of VEGF MMP-9 and E-cadherin in gastric cardia carcinoma. To explore the value and significance of combined splenectomy in the surgical treatment of cardiac carcinoma and the relationship between the expression of VEGF MMP-9 and E-cadherin and the biological behavior of gastric cardia carcinoma, and to provide new ideas and theoretical basis for the clinical diagnosis and treatment of cardiac carcinoma. Methods: from September 2003 to December 2010, 348 patients with gastric cardia carcinoma were retrospectively analyzed. 105 patients were treated with total gastrectomy combined with splenectomy. The survival rate and prognostic factors of the two groups were analyzed and the expression of VEGF MMP-9 and Ecadherin protein in cardiac carcinoma and adjacent tissues were detected by immunohistochemical method. Results the 5-year survival rate was 20.8in the splenectomy group and 30.5 in the splenectomy group. The difference between the two groups was statistically significant. The depth of tumor invasion and lymph node metastasis were important prognostic factors for cardiac cancer patients (P 0.01), while splenectomy was not an independent prognostic factor in cardiac cancer patients. The positive expression rates of VEGF MMP-9 and E-cadherin protein were 57.31% and 21.23% in gastric cardia carcinoma tissues, respectively. The positive rates of VEGF MMP-9 and E-cadherin protein were 21.23% and 21.23%, respectively, in gastric cardia carcinoma tissues, and splenectomy was not an independent prognostic factor in cardia cancer patients. The expression rates of three proteins in the tissue were 11.41% and 51.74%, respectively. The expression of the three proteins in cancer tissues and adjacent tissues was significantly different (P < 0.01.4%). The expression of VEGF and MMP-9 were related to the depth of tumor invasion and lymph node metastasis. With the increase of lymph node metastasis and depth of tumor invasion, On the contrary, the expression of E-cadherin decreased with the increase of lymph node metastasis and depth of tumor invasion. The higher the expression of VEGF and MMP-9 was, the lower the 5-year survival rate was, and the higher the expression of E-cadherin was, the lower the 5-year survival rate was. The 5-year survival rate was higher. The linear correlation analysis showed that there was a positive correlation between MMP-9 and MMP-9, and a negative correlation between MMP 9 and E-cadherin. ConclusionSplenectomy is not suitable for all types of cardiac cancer, but is suitable for patients with deep invasion and more lymph node metastasis. The depth of tumor invasion and lymph node metastasis are important prognostic factors in patients with cardiac carcinoma, while splenectomy is not an independent prognostic factor of cardiac carcinoma. 2VEGFU E-cadherin and MMP-9 play an important role in the development and metastasis of cardiac carcinoma. The abnormal expression of these three proteins can be used as an important biological index to judge the prognosis of patients.
【学位授予单位】：吉林大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R735.2

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