间皮素的表达对恶性胸膜间皮瘤预后的影响

发布时间：2019-03-15 17:34

【摘要】：[研究背景]恶性胸膜间皮瘤(Malignant pleural mesothelioma,MPM)是一个恶性程度较高的发生于胸膜间皮细胞的罕见肿瘤,其中位生存期9-12个月,同时其早期预后因子至今尚不清楚。本文章研究间皮素的高表达与恶性胸膜间皮瘤生存和预后的关系,探讨间皮素的表达是否可以作为胸膜间皮瘤患者预后的预测指标。[方法]回顾性分析2007年5月至2014年12月在山东大学第二医院病理诊断为胸膜间皮瘤及随访资料齐全的38例病例。运用免疫组织化学(immunohistochemistry,IHC)的方法对肿瘤组织进行染色,观察间皮素在胸膜间皮瘤组织中的表达,同时分析间皮素在胸膜间皮瘤中的表达水平与患者的临床基本病理特征(性别、年龄、吸烟史、分期、病理类型、至少接受过1疗程化疗)是否有关。最后建立C0X单因素及多因素回归分析模型,评估对胸膜间皮瘤患者生存与预后有影响的因素。[结果]1.患者临床基本病理特征以及间皮素的表达38例胸膜间皮瘤患者入选,平均年龄为66.11 ±9.45岁;25例(66%)患者有吸烟史;29例(76%)患者病理类型为上皮型,其余的为非上皮型(包括肉瘤型和混合型)。间皮素的高表达在吸烟者(p=0.030)及非上皮型者(p=0.002)中有显著统计学意义。间皮素的高表达与性别、年龄、吸烟、至少接受过1周期的化疗组无统计学意义。2.间皮素的表达与总生存期的相关性吸烟组其生存期(9.63±1.11月)低于非吸烟组(17.02±1.47月),差异具有统计学意义(p=0.014)。其他具有统计学意义的指标是在上皮型患者其生存期(14.62±1.32月)高于非上皮型(6.17±1.37月)(p0.001),间皮素高表达的其生存期(7.47±1.48月)低于低表达的患者(14.72±1.30月)(p=0.005)。而在性别、年龄、分期、接受过至少1周期的化疗组中差异无显著的统计学意义。单因素分析:吸烟组中吸烟患者生存期低于非吸烟者(p=0.023),非上皮型患者生存期低于上皮型患者(p0.001),间皮素高表达的患者低于低表达的患者(p=0.009),这三组差异均具有统计学意义。在多因素分析中进一步证实了非上皮类型(p=0.030)和间皮素高表达(p=0.033)可作为胸膜间皮瘤生存期的独立预后危险因素。[结论]1.间皮素的表达与患者吸烟史、病理学类型相关。2.间皮素高表达患者总生存期较低表达患者低,该研究中多因素分析表明间皮素是胸膜间皮瘤的独立预后影响因子同时也为胸膜间皮瘤的免疫治疗提供靶向位点。
[Abstract]:[background] malignant pleural mesothelioma (Malignant pleural mesothelioma,MPM) is a rare tumor with a high degree of malignancy occurring in pleural mesothelial cells, with a survival period of 9 to 12 months, and its early prognostic factors are still unknown. In this study, we studied the relationship between the high expression of mesothelin and the survival and prognosis of malignant pleural mesothelioma, and discussed whether the expression of mesothelin could be used as a predictor of prognosis in patients with pleural mesothelioma. [methods] 38 cases of pleural mesothelioma diagnosed pathologically in the second Hospital of Shandong University from May 2007 to December 2014 were retrospectively analyzed. Immunohistochemistry (immunohistochemistry,IHC) was used to study the expression of mesothelin in pleural mesothelioma, and the expression of mesothelin in pleural mesothelioma was observed. The expression of mesothelin in pleural mesothelioma was also analyzed whether the expression of mesothelin in pleural mesothelioma was related to the basic clinicopathological features (sex, age, smoking history, stage, pathological type, at least one course of chemotherapy) in patients with pleural mesothelioma. Finally, the univariate and multivariate regression analysis models of C0X were established to evaluate the factors affecting the survival and prognosis of patients with pleural mesothelioma. [result] 1. Clinical and pathological characteristics and expression of mesothelin in 38 patients with pleural mesothelioma (mean age 66.11 卤9.45 years), 25 patients (66%) had a history of smoking, and 38 patients (66%) had a history of smoking. 29 cases (76%) were of epithelial type and the others were non-epithelial type (including sarcomatoma and mixed type). The high expression of mesothelin was statistically significant in smokers (p < 0. 030) and non-epithelial type (p < 0. 0002). The high expression of mesothelin was not significantly correlated with sex, age, smoking and at least one cycle of chemotherapy. Correlation between the expression of mesothelin and total survival time: the survival time of smoking group (9.63 卤1.11 months) was lower than that of non-smoking group (17.02 卤1.47 months), the difference was statistically significant (p = 0.014). The other statistically significant indexes were the survival time of epithelial type (14.62 卤1.32 months) was higher than that of non-epithelial type (6.17 卤1.37 months) (p0.001). The survival time of the patients with high expression of mesothelin (7.47 卤1.48 months) was lower than that of the patients with low expression (14.72 卤1.30 months) (p < 0.05). There was no significant difference in sex, age, stage and at least one cycle of chemotherapy. Univariate analysis showed that the survival time of smoking patients was lower than that of non-smokers (p < 0. 023), that of non-epithelial patients was lower than that of epithelial patients (p0.001), and that of patients with high expression of mesothelin was lower than that of patients with low expression of mesothelin (p < 0. 009). The differences among the three groups were statistically significant. In multivariate analysis, it was further confirmed that non-epithelial type (p0. 030) and high expression of mesothelin (p0. 033) were independent prognostic risk factors for the survival of pleural mesothelioma. [conclusion] 1. The expression of mesothelin was correlated with smoking history and pathological type. 2. The overall survival time of patients with high expression of mesothelin was lower than that of patients with low expression. Multivariate analysis showed that mesothelin was an independent prognostic factor for pleural mesothelioma and provided a target site for immunotherapy of pleural mesothelioma.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.3

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