本文選題：鼻咽癌 + 人類白細(xì)胞抗原�。� 參考：《汕頭大學(xué)》2011年碩士論文

【摘要】：背景 鼻咽癌(nasopharyngealcarcinoma,NPC)是起源于鼻咽上皮的惡性腫瘤,也是耳鼻咽喉科最常見的惡性腫瘤。NPC在西方國家十分罕見而在中國南方人群中發(fā)病率較高,呈現(xiàn)出明顯的地區(qū)聚集性、家族聚集性和種族易感性。NPC的病因至今尚未完全明確,目前認(rèn)為主要由EB病毒、環(huán)境因素和遺傳因素等綜合作用所致。人類白細(xì)胞抗原(humanleukocyteantigen,HLA)在NPC發(fā)病過程中起著重要作用,目前已有研究證實HLA-A02、-B46、A02-B46、A33-B58等為中國南方人群NPC發(fā)生的危險性因素,而HLA-A11、-A31、-B27等為NPC發(fā)生的保護(hù)性因素。我們課題組前期通過對247例潮汕地區(qū)NPC患者和274例潮汕正常人群進(jìn)行研究也證實了在潮汕人群中HLA與NPC的相關(guān)性,并提示有NPC隱性基因存在于HLA區(qū)域內(nèi)導(dǎo)致中國南方人群NPC的發(fā)生。但目前關(guān)于HLA在NPC臨床進(jìn)展中的作用還鮮有報道,在前期研究的基礎(chǔ)上,本研究旨在探討HLA與NPC臨床進(jìn)展及預(yù)后的相關(guān)性。 目的 分析HLA-A、-B等位基因與NPC臨床特征的關(guān)系,并研究二者與NPC5年生存預(yù)后的關(guān)系。 材料與方法 回顧總結(jié)課題組前期HLA-NPC相關(guān)性研究中的NPC患者HLA-A、-B等位基因分型結(jié)果,并進(jìn)一步收集其臨床信息。本研究231例NPC患者均為潮汕籍,其中男性174例,女性57例,男女之比為3.1:1;平均年齡47.7歲(14～76歲)。HLA-A、-B等位基因與NPC患者臨床特征的相關(guān)性采用二分類Logistic回歸分析;用Kaplan-Meier方法進(jìn)行生存估計,Log-rank分析組間差異,用Cox比例風(fēng)險模型進(jìn)行生存分析。 結(jié)果 231例NPC患者整體五年生存率為65.8%,截至末次隨訪時間的總生存率為59.7%。Cox生存分析顯示,231例NPC患者中,對NPC五年生存率有顯著影響的因素有:年齡(RR=1.027)、抽煙(RR=1.781)、臨床分期(RR=2.558),以及T(RR=1.568)、N(RR=2.578)、M(RR=6.904)分期等。對臨床Ⅲ～Ⅳ期(n=167)NPC患者而言,Cox多因素分析顯示,HLA-A24等位基因?qū)ζ漕A(yù)后有顯著影響(相對風(fēng)險率RR=1.825,95%CI=1.117-2.981,P=0.016);HLA-A24攜帶者(n=53)的五年生存率明顯低于HLA-A24非攜帶者(n=114)(生存率分別為47.2%和65.8%, Log-rankP=0.029),提示HLA-A24為NPC的獨立預(yù)后因素;但所有被分析因素對Ⅰ～Ⅱ期(n=64)患者的預(yù)后無明顯影響。此外,二分類Logistic回歸分析顯示HLA-A、-B等位基因與NPC患者病理類型、淋巴結(jié)轉(zhuǎn)移與否、遠(yuǎn)處轉(zhuǎn)移與否和臨床分期等臨床特征無相關(guān)性。 結(jié)論 處于臨床Ⅲ～Ⅳ期的NPC患者,HLA-A24攜帶者的預(yù)后較非攜帶者要差,臨床檢測HLA-A24對判斷NPC患者的預(yù)后可能會有所幫助。年齡、抽煙、臨床分期及T、N、M分期是影響NPC預(yù)后的重要因素。HLA-A、-B等位基因和NPC臨床特征之間無顯著性相關(guān)。
[Abstract]:Background Nasopharyngeal carcinoma (NPC) is a malignant tumor originating from nasopharyngeal epithelium and the most common malignant tumor in the family Otolaryngology. NPC is rare in western countries and has a high incidence in southern China. The etiology of familial agglomeration and ethnic susceptibility. NPC is not completely clear. It is believed that Epstein-Barr virus (EBV), environmental factors and genetic factors are the main factors. Human leukocyte antigens (NPC) play an important role in the pathogenesis of NPC. At present, it has been confirmed that HLA-A02P46A02-B46-A33-B58 is the risk factor of NPC in southern Chinese population, while HLA-A11A31B27 is the protective factor of NPC. The previous study of 247 NPC patients and 274 normal Chaoshan people in Chaoshan area also confirmed the correlation between HLA and NPC in Chaoshan population. It is suggested that the presence of NPC recessive gene in the HLA region leads to the occurrence of NPC in southern China. However, there are few reports on the role of HLA in the clinical progress of NPC. On the basis of previous studies, the purpose of this study is to explore the correlation between HLA and clinical progress and prognosis of NPC. Purpose To analyze the relationship between HLA-AG-B allele and clinical features of NPC, and to study the relationship between HLA-AG-B allele and the survival and prognosis of NPC5. Materials and methods The results of allelic typing of HLA-An B alleles in patients with NPC were reviewed and summarized in the previous HLA-NPC correlation study of our research group, and further clinical information was collected. In this study, 231 patients with NPC were all of Chaoshan nationality, including 174 males and 57 females with a ratio of 3.1: 1.The average age of 47.7 years was 1476 years old and the correlation between HLA-AHA-B allele and clinical characteristics of NPC patients was analyzed by two-classification Logistic regression analysis. Kaplan-Meier method was used to estimate survival and Log-rank was used to analyze the differences between groups, and Cox proportional risk model was used to analyze survival. Result The overall 5-year survival rate of 231 patients with NPC was 65.8%. The overall survival rate at the end of the last follow-up period was 59.7%.Cox survival analysis. The factors that had significant influence on the 5-year survival rate of NPC patients were as follows: age of RRN 1.027, smoking of RRN 1.781, clinical stage RRV 2.558, and TRR1. 568 NRR 2.578RR6.904. Cox multivariate analysis showed that HLA-A24 alleles significantly affected the prognosis of patients with stage 鈪，

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