摘要
目的拟找出与各级恶性黑色素瘤预后相关的因素.方法选择南京军区福州总医院、福建医科大学第一附属医院及第三军医大学附属西南医院、附属新桥医院、附属大坪医院病理科1995～1998年间归档的各级恶性黑色素瘤标本55例.同时选取尸检对应部位正常组织共10份作为阴性对照.应用链霉素亲生物素-过氧化物酶标S-p法检测石蜡标本中耐药基因胎盘型谷胱甘肽-S-转移酶(GST-π)、DNA拓朴酶Ⅱ(TopoⅡ)、P-糖蛋白(Pgp)和Ki-67、血管内皮生长因子(VEGF)的表达,并用形态计量方法检测肿瘤内微血管密度(MVD),对所得的各项指标进行统计学分析.结果美国癌症联合会(AJC)分级与预后相关(P＜0.05).耐药基因Pgp、GST-π和TopoⅡ的表达率分别为36.4%(20/55=36.4%)、52.7%(29/55=52.7%)和43.6%(24/55=43.6%),相互间差异无显著性(P＞0.05).Pgp、GSTπ和TopoⅡ的表达和TopoⅡ和TopoⅡ的表达与患者预后显著相关(P＜O.05).Ki-67在肿瘤和正常组织中呈多少不等的阳性,不同级别及与非肿瘤组织之间差异有显著性.多元回归分析显示该指标是预后的独立危险因素之一,以27%为分界点两条生存曲线间时序分析差异有显著性(P＜0.01).微血管密度:AJC分级中Ⅰ级与正常黏膜组织之间的微血管密度差异无显著性,而Ⅱ、Ⅲ、Ⅳ级的微血管密度均显著增多(P＜0.01),坏死组织中微血管平均数更为增多,VEGF的表达与微血管密度呈显著性相关(P＜0.01).微血管计数＞39.5的恶性黑色素瘤比＜39.5的恶性黑色素瘤生存期显著缩短.结论用COX逐步回归模型进行多因素分析,筛选出了对恶性黑色素瘤预后有密切关系的7个指标:AJC分级是最重要的预后因子,其次为Ki-67阳性率、微血管密度、肿瘤耐药因子Pgp、TopoⅡ、GSTπ,而组织有无坏死则为保护因素.
To investigate the clinical and pathological characteristics of astrocytoma and the factors related to pathological gradings as well as prognosis in laryngopharyngeal malignant melanoma. 55 casas were selected and 10 casas of normal tissue and inflammation tissue were used as the control group. The expression of Pgp, GST-π, TopoⅡ and Ki-67 and VEGF by immunohistochemical stain and microvessel density by morphometry were studied. AJC grade were correlated with prognosis(P <0.05). The positive rates of Pgp, GST-π and TopoⅡ were 36.4%, 52.7% and 43.6% respectively in 28 cases of laryngopharyngeal malignant melanoma, without significant difference(P >0.05). The positive rates of Pgp, GST-π and TopoⅡ were correlated with prognosis (P <0.05). Both laryngopharyngeal malignant melanoma and inflammation tissue showed various positivity for Ki-67. The difference between different gradings of the tumor and non-neoplastic lesions were significant (P <0.01). Taking 27% of Ki-67 expression as threshold, there was significant difference between two survival curves indicating favorable prognosis in the tumor group respectively (P <0.01)). Microvascular changes, such as the density of blood vessels, did not demonstrate any difference between grade Ⅰ and normal tissue, but was significantly increased in grade Ⅱ, Ⅲand Ⅳ laryngopharyngeal malignant melanoma and even more in the necrotic area (P <0.01). The expression of VEGF correlated closely to the density of the blood vessel (P <0.01). An average vessel count of less than 39.5 (X200) suggested a better survival,but a higher vessel count of more than 39.5 (X200) showed a trand to worse the overall survival. [Conclusion] Use of the cox-regression model in multivariate analysis shows that there are six parameters closely related to the prognosis of laryngopharyngeal malignant melanoma, of which the AJC grade being the most critical factor. Ratio of Ki-67 positivity, microvessel density, Pgp, TopoⅡ and GST-π, while necrosis in tumor are independent favorable factors for laryngopharyngeal malignant melanoma.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2005年第5期719-722,共4页
China Journal of Modern Medicine
关键词
恶性黑色素瘤
预后
因果律
malignant melanoma
prognosis
causality
