食管鳞癌术后复发进展模式与Tiam1表达水平相关性分析

发布时间：2018-10-24 17:18

【摘要】：目的:通过回顾分析经左胸食管癌根治术术后复发进展模式,指导术后三维适形放射治疗的布野设计;初步探讨Tiam1在食管鳞癌术后病理组织中表达水平与预后及进展部位的相关性。方法:对经经左胸食管癌根治术、R0切除、病理确诊的食管癌根治术后复发进展患者96例,术后分期按AJCC第7版分期标准分期。将适合术后放疗设野患者分为:隆突以上复发或淋巴结转移及吻合口复发,包括双侧锁骨上至环甲膜水平下淋巴结转移,称为隆突以上进展;隆突下复发转移及腹腔淋巴结转移,包括贲门旁、胃左、腹主动脉旁(肾动脉水平以上),称为隆突下进展。将术后进展部位不能涵盖在靶区内患者定义为:远处脏器组织转移。出现以上两类或两类以上进展,称为复合进展。回顾分析患者复发进展模式。然后扩大随访病例,依据患者复发转移部位,分为局部转移、远处转移、和混合转移,术后分期标准均依据AJCCfUICC 2010版标准分期,原发部位按AJCC/UICC2010版标准分段,依次分为胸上段、胸中段、胸下段;进展情况按复发转移部位分为局部转移、远处转移和混合转移。局部转移定义为包括原位复发、纵隔及锁骨上淋巴结转移;远处转移定义为除局部转移外其它脏器组织转移;混合转移定义为包含局部及远处转移。通过免疫组织化学检测术后病理组织Tiam1表达水平,纳入306例2009年09月至2014年06月期间在扬州大学附属医院行根治性食管癌切除术患者,剔除11例随访资料不全患者后,剩余295例纳入本研究最终分析。分析患者Tiam1表达水平,按免疫组化染色评分法(IRS)进行半定量,分为低、中、高表达,对比分析Tiam1表达水平与患者无病生存期(DFS)相关性及Tiam1表达水平与进展部位关系。结果:在所研究96例食管癌术后进展患者中,出现隆突以上进展、隆突以下进展、远处转移及复合进展患者分别占比53.1%、13.5%、22.9%和10.4%,以隆突以上进展者最多。对术后给予放疗或放化疗联合治疗患者分层分析,出现隆突以上进展者占比仅为37.1%。而对于术后未予放疗患者,隆突以上进展者占比高达63.8%。295例患者中出现疾病进展236例,Tiam1高表达145例、中低表达150例,Tiam1表达水平与患者术后病理分期、淋巴结转移状况及T分期具备相关性,Tiam1表达水平与患者DFS时间相关,高表达患者总体预后较差,此外,对病理分期晚、高T分期及Tiam1高表达患者,结果提示与患者出现远处转移具有相关性。结论:食管癌术后进展情况以局部复发转移为主;对于术后考虑放疗的患者,给予上纵隔联合锁骨上野预防性照射,可能会带来局部控制获益,尤其对胸中上段肿瘤患者可考虑给予淋巴引流区预防性照射。ESCC根治术后,病理组织Tiam1高表达的患者预后较差;Tiam1高表达与术后出现远处转移存在相关性。
[Abstract]:Objective: to analyze the pattern of recurrence and progression after radical resection of esophageal carcinoma through left chest, and to guide the design of three-dimensional conformal radiotherapy. To investigate the correlation between the expression of Tiam1 and prognosis and progression of esophageal squamous cell carcinoma after operation. Methods: 96 patients with recurrence and progression after radical resection of esophageal carcinoma through left thoracic resection, R0 resection and pathological diagnosis, were staging according to the seventh edition of AJCC. The patients who were suitable for postoperative radiotherapy were divided into three groups: recurrence of Carina or lymph node metastasis and recurrence of anastomotic stoma, including bilateral supraclavian to cyclidine level lymph node metastasis, known as the progress of Carina; Subcarinal recurrence and abdominal lymph node metastasis, including parachordia, left stomach, abdominal aorta (above renal artery level), is called subcarinal progression. The patient who can not be covered in the target area after operation is defined as distant organ tissue metastasis. The occurrence of two or more types of progress is called compound progress. The pattern of recurrence and progression was analyzed retrospectively. Then according to the site of recurrence and metastasis, the patients were divided into local metastasis, distant metastasis, and mixed metastasis. The postoperative staging criteria were all based on AJCCfUICC 2010 standard staging, and the primary sites were divided into upper thoracic segment according to AJCC/UICC2010 standard. The progress was divided into local metastasis, distant metastasis and mixed metastasis according to the site of recurrence and metastasis. Local metastasis includes in situ recurrence mediastinal and supraclavicular lymph node metastasis; distant metastasis is defined as other organ metastasis except local metastasis; mixed metastasis is defined as including local and distant metastasis. The expression of Tiam1 in postoperative pathological tissues was detected by immunohistochemistry. 306 patients underwent radical resection of esophageal carcinoma from September 2009 to June 2014 in Yangzhou University Hospital, excluding 11 patients with incomplete follow-up data. The remaining 295 cases were included in the final analysis of this study. The expression level of Tiam1 was analyzed, and the expression of (IRS) was divided into low, middle and high expression according to the immunohistochemical staining score. The correlation between Tiam1 expression and (DFS) in disease-free survival was compared and the relationship between the expression of Tiam1 and the location of disease free survival was analyzed. Results: among the 96 patients with postoperative progress of esophageal cancer, there were more progress than Carina, and the proportion of patients with distant metastasis and compound progression were 53.1% and 10.4%, respectively. According to the stratified analysis of patients who received radiotherapy or combined radiotherapy and chemotherapy, the proportion of patients with more than protuberance was only 37.1%. However, for the patients without postoperative radiotherapy, the proportion of patients with advanced protuberance was as high as 63.8.295 cases with disease progression, 145 cases with high expression of Tiam1 and 150 cases with low expression. The expression level of Tiam1 was correlated with the postoperative pathological stage. Lymph node metastasis and T stage were correlated. The expression of Tiam1 was correlated with the time of DFS, and the overall prognosis of the patients with high expression was poor. In addition, the patients with late pathological stage, high T stage and high expression of Tiam1. The results suggest that there is a correlation with distant metastasis. Conclusion: local recurrence and metastasis are the main progression of esophageal cancer after operation, and local control may benefit from preventive radiation of upper mediastinum combined with upper clavicle field for patients who consider radiotherapy after operation. Especially for the patients with upper and middle thoracic tumors, the patients with lymphatic drainage area should be given prophylactic irradiation. After ESCC radical operation, the prognosis of patients with high expression of Tiam1 in pathological tissues was poor, and the high expression of Tiam1 was correlated with distant metastasis after operation.
【学位授予单位】：扬州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.1

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