摘要
目的探讨影响大肠癌预后相关因素,为临床医师评估及预测大肠癌患者预后提供一定的科学依据。方法选取根治术大肠癌厉发病例120例,查阅病历及5年以上随访资料。并取病例样本存档石蜡块,切片后进行SP免疫组化方法检测CD44v6、p16、Ki67、MMP-9四个蛋白表达物。结果CD44v6、p16、Ki67、MMP-9蛋白在120例大肠癌组织中阳性表达率分别为31.70%(38/120),、40.80%(49/120)、55.80%(67/120)和46.70%(56/120)。将分子生物学标志物与临床病理指标相结合,经Cox单因素分析,大体分型、组织学分型、浸润深度、淋巴结转移、Dukes’分期、CD44v6、p16、Ki67和MMP-9为有意义的预后因素(a=0.05);经CoX多因素分析,最终进入模型的因素为Dukes'分期、p16和MMP-9,RR值分别为3.138、0.444和1.841,由此建立的大肠癌术后生存预测模型为:h(t,x)=h0(t)exp(1.144X9+0.610X13-0.813X11),其预测预后的灵敏度为79.10%,特异度为67.92%,Kappa值(K)为0.4731。结论Dukes’分期、p16和MMP-9很可能是影响大肠癌患者预后的独立因素,显示预后预测模型具有较高的效度和信度,可为临床医师判断大肠癌患者的预后提供一定的参考依据。
Objective To discuss the correlation of expression of CD44v6,pl 6,Ki67, MMP - 9 and the prognosis of colorectal cancer（CRC） and provide scientific basis for prognosis of the disease by physicians. Methods There 120 CRC cases were included in this study. Medical and clinical records and 5 - year follow - up data were reviewed. Streptavidin - peroxidase immunohistochemical technique was used to detect the expression of CD44vt, p16, Kit7 and MMP -9 on formalin -fixed, paraffin embedded sections of CRC from the 120 patients. Results The positive expression rate of CD44vt, pl6, Kit7 and MMP-9 proteins in 120 CRC patients was 31.70% （38/120）, 40.80% （49/120）, 55.80% （67/120） and 46.70% （56/ 120）, respectively. There were correlation of the ecpression of CD44v6 protein and lymph node metastasis, Dukes＇stage; There was correlation between the expression of p16 protein and general tying. The expression of Ki67 protein was associated with tumour sites, lymph node metastasis, Dukes＇stage;There association of expression of MMP -9 protein and lymph node metastasis was also observed. All pathological variables and biological markers were analyzed with Cox regression model. The results of Cox univariate analysis show that macroscopic configuration, histology grades, invasion depth, lymph node metastasis, Dukes stage and CD44vt, p16, Ki67, MMP -9 were significantly prognositic factors （at the level of a =0.05 ） ;The results of Cox multivariate analysis show that Dukes stage, p16 and MMP -9 enter into final model,with RR values of 3. 138, 0.444 and 1.841, respectively ;prognostic model is h （ t, x） = h0 （t） exp （ 1.144X9 ＋ 0.610X13 - 0.813 X n ）. Sensitivity, specificity agreement and reliability of the model and Kappa value were 79.10% ,67.92% ,74.17% and 0.4731, respectively. Conclusion The factors of Dukes＇stage, p16 and MMP -9 are possibly the independent factors influencing CRC prognosis. The establishment of CRC prognostic model is worthwile and it can meet the need of clinical practice.
出处
《中国热带医学》
CAS
2008年第5期745-748,共4页
China Tropical Medicine
基金
山西省自然科学基金项目编号991076
山西省教委厅资助项目
