本文選題：KI-67 + 膀胱橫紋肌肉瘤　； 參考：《南方醫(yī)科大學》2017年碩士論文

【摘要】：目的及背景:橫紋肌肉瘤(RMS)是最常見的軟組織腫瘤,在兒童和青少年腫瘤中占5%。在美國20歲以下的患者中,每年估計有350例新病例診斷RMS。相比之下,RMS是非常罕見于成人的,其有輕微的男性優(yōu)勢(男性發(fā)病人數(shù)是女性的1.4倍),但是統(tǒng)計學上沒有發(fā)病率的顯著差異。橫紋肌肉瘤可以發(fā)生在身體的任何部位,但是橫紋肌肉瘤的發(fā)生機制及遺傳機制直至目前仍不甚了解。有文章總結了最近的全基因組研究,認識到PAX-FKHR基因融合狀態(tài)在RMS中的預后價值,其中甚至牽連了腫瘤的逃避抑制機制,但仍不能提出能夠應用的診斷和預后生物標志物,以應對個體靶向治療和顯著改善橫紋肌肉瘤的預后。因此尋找、發(fā)現(xiàn)一個能夠方便準備預測橫紋肌肉瘤患者生存的因素(如病理分期系統(tǒng)、臨床分期系統(tǒng)、分子生物標記物)迫在眉睫。Ki-67蛋白是可識別的細胞周期中的核抗原,與細胞增殖密切相關。在泌尿系腫瘤中,大多數(shù)文獻認為Ki-67蛋白在泌尿系腫瘤中的表達與腫瘤分級、TNM分期、術后復發(fā)、轉移和預后高度相關,尤其是在其術后預后方面的作用。但關于KI-67在橫紋肌肉瘤中的研究現(xiàn)在還非常稀少,因此本研究采用免疫組化的方法檢測橫紋肌肉瘤組織中Ki-67蛋白的表達,探討Ki-67和橫紋肌肉瘤患者預后之間的關系。方法:收集南方醫(yī)科大學珠江醫(yī)院2010年1月份至2016年1月份的26例兒童(14歲以下)膀胱橫紋肌肉瘤組織。其中男性23人,女性3人;年齡從1歲至9歲,平均年齡為3.7±1.5歲。采用免疫組化S-P法檢測這些腫瘤標本的KI-67蛋白的表達,并采用常用的統(tǒng)計學分析軟件IMB SPSS 20.0軟件進行統(tǒng)計學分析,在KI-67蛋白表達與患者年齡、腫瘤大小(cm)的分析中采用兩樣本獨立T檢驗,KI-67蛋白的表達與性別、肌層侵犯、切緣陽性、腫瘤數(shù)目中采用卡方分析,采用秩和檢驗分析KI-67蛋白的表達與橫紋肌肉瘤Stage分期。臨床分組和危險分層的相關性。采用Kaplan-Meier方法分析KI-67蛋白表達與兒童橫紋肌肉瘤術后預后關系。最后還初步探索KI-67蛋白的表達在兒童橫紋肌肉瘤的化療前后的變化。結果:研究發(fā)現(xiàn)KI-67在兒童橫紋肌肉瘤的表達與患者的性別、年齡無相關,但在病理組織學特征方面,我們發(fā)現(xiàn)KI-67蛋白表達與腫瘤大小、切緣陽性、肌層侵犯、腫瘤數(shù)目未顯示出顯著的相關性,但其KI-67蛋白的表達與是否出現(xiàn)淋巴結轉移是強相關(p=0.033,0.05P0.01),沒有發(fā)現(xiàn)KI-67蛋白在兒童橫紋肌肉瘤中的表達與Stage分期、臨床分組、危險分層之間的相關性,經(jīng)Kaplan-meier法進行預后分析,我們仍然可以看到KI-67高表達組與KI-67低表達之間在生存預后方面有明顯的統(tǒng)計學差異(P=0.0108,P0.05),KI-67低表達組患者比Ki-67高表達組患者擁有更好的預后。結論:在兒童膀胱橫紋肌肉瘤患者中,KI-67低表達組患者比Ki-67高表達組患者擁有更好的預后,可以說KI-67蛋白的表達是兒童膀胱橫紋肌肉瘤術后的預后因素。
[Abstract]:Objective and background: rhabdomyosarcoma (RMS) is the most common soft tissue tumor in children and adolescents. An estimated 350 new cases of RMS are diagnosed annually in patients under the age of 20 in the United States. By contrast RMS is very rare in adults and has a slight male predominance (the number of male cases is 1.4 times higher than that of females but there is no statistically significant difference in the incidence of RMS). Rhabdomyosarcoma can occur in any part of the body, but the pathogenesis and genetic mechanism of rhabdomyosarcoma are still unknown. Some articles have summarized the recent genome studies and recognized the prognostic value of PAX-FKHR gene fusion status in RMS, which even implicated in the mechanism of tumor escape inhibition, but it is still unable to propose diagnostic and prognostic biomarkers that can be applied. In order to deal with individual targeted therapy and significantly improve the prognosis of rhabdomyosarcoma. Therefore, to find a factor (such as pathological staging system, clinical staging system, molecular biomarker) that can be easily prepared to predict the survival of rhabdomyosarcoma patients, the Ki-67 protein is identified as the nuclear antigen in the cell cycle. It is closely related to cell proliferation. In urological tumors, the expression of Ki-67 protein in urological tumors is highly correlated with tumor grade, recurrence, metastasis and prognosis, especially in postoperative prognosis. However, the study of KI-67 in rhabdomyosarcoma is still very rare, so the expression of Ki-67 protein in rhabdomyosarcoma was detected by immunohistochemical method to explore the relationship between Ki-67 and prognosis of rhabdomyosarcoma. Methods: 26 cases of bladder rhabdomyosarcoma from January 2010 to January 2016 in Zhujiang Hospital of Southern Medical University were collected. There were 23 males and 3 females, aged from 1 to 9 years, with an average age of 3.7 鹵1.5 years. Immunohistochemical S-P method was used to detect the expression of KI-67 protein in these tumor specimens, and IMB SPSS 20.0 software was used to analyze the expression of KI-67 protein with the age of the patients. The expression and sex of KI-67 protein, invasion of muscle layer, positive margin of tumor, chi-square analysis and rank sum test were used to analyze the expression of KI-67 protein and Stage stage of rhabdomyosarcoma. Correlation between clinical grouping and risk stratification. Kaplan-Meier method was used to analyze the relationship between the expression of KI-67 protein and postoperative prognosis of children with rhabdomyoma. Finally, the expression of KI-67 protein before and after chemotherapy in children rhabdomyosarcoma was preliminarily investigated. Results: the expression of KI-67 in rhabdomyosarcoma of children was not correlated with sex and age, but in histopathological features, we found that the expression of KI-67 protein was correlated with tumor size, incisal margin positive, and invasion of muscle layer. There was no significant correlation between the number of tumors, but the expression of KI-67 protein was strongly correlated with lymph node metastasis. There was no significant correlation between the expression of KI-67 protein and Stage stage and clinical grouping in children rhabdomyosarcoma. The correlation between risk stratification was analyzed by Kaplan-meier method. We can still see that there is a significant difference in survival and prognosis between the high expression group of KI-67 and the low expression of KI-67. The patients with low expression of P0. 0108 and P0. 05 + KI-67 have better prognosis than those with high expression of Ki-67. Conclusion: in children with bladder rhabdomyosarcoma, the patients with low expression of KI-67 have better prognosis than those with high expression of Ki-67. It can be said that the expression of KI-67 protein is a prognostic factor in children with bladder rhabdomyosarcoma after operation.
【學位授予單位】：南方醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.14

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相關期刊論文 前10條

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本文編號：1910055