血清铁蛋白与头颈部鳞状细胞癌颈部淋巴结转移的相关性研究

发布时间：2018-05-15 19:21

本文选题：血清铁蛋白 + HNSCC　；参考：《武汉大学》2017年博士论文

【摘要】：目的：颈部淋巴结转移是影响头颈部鳞状细胞癌患者预后的重要因素。临床中B超是检测淋巴结转移的最常见方法之一,但其精确性有待进一步提高。本研究的目的是探究血清铁蛋白在头颈部鳞状细胞癌局部转移中的作用,为局部淋巴结转移的诊断提供一种新的分子标志物。方法：收集70例头颈部鳞状细胞癌患者的病例资料及标本,所有患者术前均查血清铁蛋白、颈部B超,术中均行颈淋巴结清扫术。术后根据病理结果将患者分为转移组和非转移组。B超主要记录淋巴结两个指标：最大淋巴结长径、长短径之比；收集的血清标本利用增强化学法检测血清铁蛋白水平,分别分析B超、血清铁蛋白与颈部淋巴结转移的相关性。再利用来自TCGA的数据分析铁蛋白与头颈部鳞癌患者生存率的关系。然后我们利用收集的组织标本进行免疫组化及铁染色实验,分析组织中铁蛋白与头颈部鳞癌转移的相关性。最后我们利用生物信息学方法对铁蛋白在头颈部鳞状细胞癌转移中的分子机制进行综合分析。结果：临床颈部淋巴结清扫的阳性率仅为42.9%,利用淋巴结长径诊断淋巴结转移的敏感性和特异性分别为60.0%、62.5%,利用长短径之比诊断淋巴结转移的敏感性和特异性分别为20.0%、10.0%。B超检测的淋巴结最长径、长短径之比与淋巴结转移无统计学意义(P0.05)。利用血清铁蛋白诊断淋巴结转移的敏感性和特异性分别为86.7%、77.5%,血清铁蛋白与淋巴结转移有明显统计学意义(P0.01)。TCGA数据分析铁蛋白mRNA表达高的头颈部鳞癌患者生存率明显降低；组织学实验进一步验证了铁蛋白在伴转移的癌组织中表达增高,另外,铁在该过程中也可能发挥了重要作用。结论：临床中单纯利用颈部B超判断局部淋巴结转移敏感性及特异性均较低,血清铁蛋白对局部淋巴结转移的诊断及预测有较高敏感性；铁蛋白在伴转移的癌组织及淋巴结中表达增高；铁蛋白促进转移的机制可能通过多基因多通路相互作用实现。
[Abstract]:Objective: cervical lymph node metastasis is an important factor in prognosis of head and neck squamous cell carcinoma. B-ultrasound is one of the most common methods for detecting lymph node metastasis, but its accuracy needs to be further improved. The purpose of this study was to explore the role of serum ferritin in local metastasis of head and neck squamous cell carcinoma and to provide a new molecular marker for the diagnosis of local lymph node metastasis. Methods: the data and specimens of 70 patients with head and neck squamous cell carcinoma were collected. All patients were examined for serum ferritin, cervical B-ultrasonography and neck lymph node dissection before operation. According to the pathological results, the patients were divided into metastatic group and non-metastatic group. B ultrasound mainly recorded two indexes of lymph nodes: the ratio of the length and length of the largest lymph node, the ratio of the length to the length of the lymph node, and the serum samples were collected to detect the serum ferritin level by enhanced chemical method. The relationship between B-ultrasound, serum ferritin and cervical lymph node metastasis was analyzed. Data from TCGA were used to analyze the relationship between ferritin and survival rate in patients with head and neck squamous cell carcinoma. Then we analyzed the correlation between ferritin and metastasis of head and neck squamous cell carcinoma by immunohistochemistry and iron staining. Finally, we used bioinformatics to analyze the molecular mechanism of ferritin in the metastasis of head and neck squamous cell carcinoma. Results: the positive rate of clinical neck lymph node dissection was only 42.9. The sensitivity and specificity of using long diameter lymph node to diagnose lymph node metastasis were 60.0 and 62.5, respectively. The sensitivity and specificity of using the ratio of long and short diameter to diagnose lymph node metastasis were as follows: 20. 0 and 10. 0. B ultrasonic examination of the longest diameter of lymph nodes, There was no significant difference between the ratio of long and short diameter and lymph node metastasis (P 0.05). The sensitivity and specificity of serum ferritin in the diagnosis of lymph node metastasis were 86.7 and 77.5, respectively. The survival rate of head and neck squamous cell carcinoma patients with high expression of ferritin mRNA was significantly lower than that of control group. The histopathological results further demonstrated that the expression of ferritin was increased in cancer with metastasis, and iron may play an important role in this process. Conclusion: the sensitivity and specificity of detecting local lymph node metastasis by simply using cervical B-mode ultrasound is low, and serum ferritin is highly sensitive to the diagnosis and prediction of local lymph node metastasis. The expression of ferritin in cancer tissues and lymph nodes with metastasis is increased, and the mechanism of promoting metastasis may be realized by the interaction of multiple genes and pathways.
【学位授予单位】：武汉大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R739.91

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