本文選題：VEGF-C + Ki67�。� 參考：《安徽醫(yī)科大學(xué)》2011年碩士論文

【摘要】：背景與目的:鼻咽癌(nasopharyngeal carcinoma,NPC)的預(yù)后與許多因素有關(guān),頸部淋巴結(jié)有無(wú)轉(zhuǎn)移對(duì)鼻咽癌的預(yù)后有很大的影響。VEGF-C,Ki67,nm23-H1的表達(dá)對(duì)鼻咽癌頸部淋巴結(jié)轉(zhuǎn)移的作用國(guó)內(nèi)外很少見(jiàn)報(bào)道。本研究擬通過(guò)檢測(cè)VEGF-C,Ki67,nm23-H1在鼻咽癌中的表達(dá)并分析其與不同臨床病理特征、預(yù)后的關(guān)系,探討三者在鼻咽癌頸部淋巴結(jié)轉(zhuǎn)移發(fā)生過(guò)程中的作用及相關(guān)性。 方法:選擇2001年8月至2006年12月在安徽省立醫(yī)院耳鼻咽喉科活檢的鼻咽癌組織存檔石蠟標(biāo)本44例,男29例,女15例,男:女=1.93:1;年齡26-81歲,中位年齡55歲。采用免疫組化SP法檢測(cè)標(biāo)本中腫瘤組織VEGF-C,Ki67,nm23-H1蛋白的陽(yáng)性表達(dá)率,并對(duì)全部病例進(jìn)行隨訪。數(shù)據(jù)采用SPSS13.0軟件進(jìn)行統(tǒng)計(jì)分析,VEGF-C,Ki67,nm23-H1蛋白表達(dá)組間差異比較采用χ2檢驗(yàn);預(yù)后的單因素分析采用Kaplan-meier曲線,組間比較應(yīng)用log-rank檢驗(yàn);預(yù)后的多因素分析采用Cox比例風(fēng)險(xiǎn)模型;相關(guān)分析采用spearman等級(jí)相關(guān)分析方法。P0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果: VEGF-C、Ki67、nm23-H1在NPC組織中的陽(yáng)性表達(dá)率分別為72.7%、77.3%、45.5%。VEGF-C、Ki67、nm23-H1的陽(yáng)性表達(dá)率均與T分期、臨床分期、KPS評(píng)分、是否貧血等均無(wú)關(guān)(P0.05),而與年齡、N分期、首程治療是否達(dá)到CR、生存時(shí)間是否大于5年有顯著相關(guān)性(P0.05)。VEGF-C與Ki67呈正相關(guān)性(r=0.97,P=0.000),與nm23-H1負(fù)相關(guān)(r=-0.66,P=0.016),Ki67與nm23-H1無(wú)相關(guān)性(P=0.074)。VEGF-C和Ki67在頸淋巴結(jié)陽(yáng)性組的表達(dá)率明顯高于頸淋巴結(jié)陰性組(P0.05),而nm23-H1則相反,且有統(tǒng)計(jì)學(xué)差異。全組病例死亡25例,生存19例,中位生存時(shí)間46.5個(gè)月(生存時(shí)間8—98個(gè)月),3年、5年生存率分別為65.9%、43.2%。單因素分析顯示:性別、年齡、治療前KPS評(píng)分、T分期、N分期、臨床分期、首程治療后是否完全緩解、VEGF-C、Ki67及nm23-H1等11個(gè)因素對(duì)鼻咽癌生存有影響(P0.05),多因素回歸分析表明,N分期、首程治療后是否完全緩解、VEGF-C是鼻咽癌患者獨(dú)立的預(yù)后因素(P0.05)。 結(jié)論: 1、VEGF-C和Ki67在頸部淋巴結(jié)陽(yáng)性的患者中的表達(dá)高于無(wú)淋巴結(jié)轉(zhuǎn)移者,兩者呈正相關(guān),提示兩者可能對(duì)頸部淋巴結(jié)轉(zhuǎn)移起了正協(xié)同作用,并且顯著影響了患者遠(yuǎn)期生存率,是預(yù)后的不良因素。Ki67和nm23-H1高表達(dá)患者的首程CR率明顯高于低表達(dá)患者,VEGF-C在鼻咽癌組織中的表達(dá)則相反,顯示NPC組織中Ki67、nm23-H1高表達(dá)、VEGF-C低表達(dá)的患者對(duì)放療更加敏感。 2、nm23-H1在頸部淋巴結(jié)陽(yáng)性患者表達(dá)率小于無(wú)頸部淋巴結(jié)轉(zhuǎn)移患者,且nm23-H1高表達(dá)的5年生存率明顯高于低表達(dá)患者,是較好的預(yù)后因素。 3、N分期、首程治療后是否完全緩解、VEGF-C是鼻咽癌患者獨(dú)立的預(yù)后因素。包括性別、年齡、治療前KPS評(píng)分、T分期、臨床分期、Ki67及nm23-H1,可作為預(yù)測(cè)鼻咽癌臨床療效和判斷預(yù)后的參考指標(biāo)。
[Abstract]:Background & objective: the prognosis of nasopharyngeal carcinoma NPCs is related to many factors. The effect of VEGF-Cnm23-H1 expression on the cervical lymph node metastasis of nasopharyngeal carcinoma is rarely reported at home and abroad. The purpose of this study was to investigate the expression of VEGF-Cnm23-H1 in nasopharyngeal carcinoma (NPC) and its relationship with different clinicopathological features and prognosis, and to explore the role and correlation of VEGF-Cnm23-H1 in cervical lymph node metastasis of nasopharyngeal carcinoma (NPC). Methods: from August 2001 to December 2006, 44 paraffin specimens of nasopharyngeal carcinoma (29 males and 15 females), aged 26-81 years, with median age of 55 years, were selected from the Department of Otorhinolaryngology of Anhui Provincial Hospital. Immunohistochemical SP method was used to detect the positive expression rate of VEGF-Cnm23-H1 protein in tumor tissue, and all cases were followed up. Statistical analysis was carried out by SPSS 13.0 software and 蠂 2 test was used to compare the difference of expression of VEGF-Cnm23-H1 protein, Kaplan-meier curve and log-rank test were used for univariate analysis of prognosis, Cox proportional risk model was used for multivariate analysis of prognosis. Correlation analysis using spearman grade correlation analysis method. P05 as the difference was statistically significant. Results: the positive expression rates of VEGF-Cnm23-H1 in NPC tissues were 72.7and 77.3nm23-H1, respectively. The positive expression rates of VEGF-Cnm23-H1 were correlated with T stage, clinical stage, KPS score, anemia, etc. Whether the survival time of the first course of treatment is more than 5 years is significantly higher than that of the patients with nm23-H1. The positive correlation between VEGF-C and Ki67 is significant. The positive expression rate of VEGF-C and Ki67 is significantly higher than that of nm23-H1 negative correlation with nm23-H1. There is no correlation between nm23-H1 and nm23-H1. The expression rate of VEGF-C and Ki67 in cervical lymph nodes is significantly higher than that in nm23-H1 positive patients with nm23-H1. The positive rate of VEGF-C and Ki67 is significantly higher than that of nm23-H1. In sex group, P0.05, nm23-H1 was the opposite. And there is statistical difference. 25 cases died, 19 cases survived, the median survival time was 46.5 months (survival time 8-98 months), the 3-year and 5-year survival rates were 65.9% and 43.23.2respectively. Univariate analysis showed that sex, age, KPS score, T stage and N stage before treatment, clinical stage, complete remission of VEGF-CU Ki67 and nm23-H1 after first course of treatment had influence on the survival of nasopharyngeal carcinoma (NPC) (P 0.05). Complete remission of VEGF-C is an independent prognostic factor in nasopharyngeal carcinoma (NPC) patients after the first course of treatment (P 0.05). Conclusion: 1 the expression of VEGF-C and Ki67 in the patients with cervical lymph node positive was higher than that in the patients without lymph node metastasis, and the positive correlation was found between the two groups, which suggested that the expression of VEGF-C and Ki67 might play a positive synergistic role in cervical lymph node metastasis. The first stage CR rate of patients with high expression of Ki67 and nm23-H1 was significantly higher than that of patients with low expression of VEGF-C in nasopharyngeal carcinoma. The results showed that the patients with high expression of Ki67nm23-H1 and low expression of VEGF-C were more sensitive to radiotherapy. 2the positive expression rate of nm23-H1 in cervical lymph nodes was lower than that in patients without cervical lymph node metastasis, and the 5-year survival rate of patients with high expression of nm23-H1 was significantly higher than that of patients with low expression. 3N stage and complete remission after first treatment were independent prognostic factors for nasopharyngeal carcinoma. It includes sex, age, KPS score and T stage before treatment, clinical staging, Ki67 and nm23-H1, which can be used as a reference index to predict the clinical efficacy and prognosis of nasopharyngeal carcinoma.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R739.63

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