本文選題：食管鱗癌　切入點(diǎn)：脈管瘤栓　出處：《四川醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:食管鱗癌患者脈管內(nèi)瘤栓對(duì)食管鱗癌患者的影響患者已受到越來越多學(xué)者的關(guān)注和研究。食管鱗癌患者脈管內(nèi)出現(xiàn)瘤栓這一病理現(xiàn)象的出現(xiàn)可能主要與腫瘤自身所具有的侵襲性和轉(zhuǎn)移性兩種特性有關(guān)�，F(xiàn)有的研究結(jié)果已經(jīng)證實(shí)Podoplanin和Twist有介導(dǎo)腫瘤發(fā)生和增強(qiáng)腫瘤轉(zhuǎn)移和侵襲的作用,在腫瘤的侵襲和轉(zhuǎn)移過程中發(fā)揮了十分重要的影響。本實(shí)驗(yàn)將觀察Podoplanin和Twist在食管鱗癌患者中的表達(dá)情況,分析這兩種蛋白陽性表達(dá)與食管鱗癌患者脈管內(nèi)出現(xiàn)瘤栓的關(guān)系,并進(jìn)一步分析其表達(dá)與淋巴結(jié)轉(zhuǎn)移、腫瘤分化等臨床特征以及患者預(yù)后之間的關(guān)系,探究可能影響食管鱗癌患者的危險(xiǎn)因素,為臨床上對(duì)于這類患者的治療提供參考依據(jù),以期盡可能減少腫瘤的復(fù)發(fā),延長(zhǎng)食管鱗癌患者的無病生存時(shí)間以及總生存時(shí)間。方法對(duì)四川省腫瘤醫(yī)院胸外科一病區(qū)在2010年6月至2012年6月間有完整臨床病理資料和隨訪記錄的70例食管鱗癌患者(脈管瘤栓陽性食管鱗癌患者35例,脈管瘤栓陰性食管鱗癌患者35例)的術(shù)后病理標(biāo)本進(jìn)行免疫組化,SP染色。顯微鏡下分別觀察Podoplanin、Twist兩種蛋白在不同的部位,即腫瘤組織和脈管瘤栓中的表達(dá),并選擇同期70例患者的正常食管組織進(jìn)行對(duì)照比較,分析1、兩種蛋白在腫瘤組織與正常組織間是否存在差異;2、這兩種蛋白在腫瘤細(xì)胞中的表達(dá)與患者脈管內(nèi)出現(xiàn)瘤栓之間的關(guān)系,并進(jìn)一步分析其表達(dá)與患者年齡、性別、腫瘤浸潤(rùn)深度(t分期)、腫瘤分化程度、淋巴結(jié)轉(zhuǎn)移這些臨床病理特征之間的關(guān)系;3、兩種蛋白在腫瘤細(xì)胞和脈管瘤栓的表達(dá)是否一致;4、兩種蛋白在血管瘤栓和淋巴管瘤栓中的表達(dá)是否有選擇性。5、腫瘤復(fù)發(fā)(即無病生存期)與這兩種蛋白表達(dá)、脈管內(nèi)出現(xiàn)瘤栓、淋巴結(jié)轉(zhuǎn)移等這些危險(xiǎn)因素之間的聯(lián)系。結(jié)果:正常食管組織中podoplanin陽性表達(dá)率為34.2%,腫瘤組織podoplanin陽性表達(dá)率為62.8%,兩組差異性明顯(p0.05);正常組織中twist陽性表達(dá)率為42.9%,腫瘤組織中twist陽性表達(dá)率為77.1%,兩組同樣差異性顯著(p0.05)。脈管瘤栓陽性食管鱗癌患者腫瘤細(xì)胞內(nèi)podoplanin陽性率77.1%,脈管瘤栓陰性食管鱗癌患者腫瘤細(xì)胞內(nèi)podoplanin陽性率48.6%,差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。淋巴結(jié)轉(zhuǎn)移陽性的食管鱗癌患者腫瘤細(xì)胞內(nèi)podoplanin陽性率71.9%,淋巴結(jié)轉(zhuǎn)移陰性的食管鱗癌患者腫瘤細(xì)胞內(nèi)podoplanin陽性率23.1%,差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。腫瘤細(xì)胞內(nèi)podoplanin陰性的食管鱗癌患者平均無病生存期15.2月,顯著優(yōu)于腫瘤細(xì)胞內(nèi)podoplanin陽性的食管鱗癌患者(p0.05)。食管鱗癌患者年齡、性別、腫瘤浸潤(rùn)深度、腫瘤分化程度與podoplanin在腫瘤細(xì)胞中的表達(dá)之間不存在相關(guān)性(p0.05);脈管瘤栓陽性食管鱗癌患者腫瘤細(xì)胞內(nèi)twist表達(dá)率74.3%,脈管瘤栓陰性食管鱗癌患者腫瘤細(xì)胞內(nèi)twist表達(dá)率80%,兩組間twist的表達(dá)差異不具有統(tǒng)計(jì)學(xué)意義(p0.05);食管鱗癌患者腫瘤細(xì)胞內(nèi)twist陰性表達(dá)組平均無病生存期8.3月,與食管鱗癌患者腫瘤細(xì)胞內(nèi)twist陽性表達(dá)組之間無顯著差異(p0.05);食管鱗癌患者年齡、性別、腫瘤浸潤(rùn)深度、腫瘤分化程度、淋巴結(jié)轉(zhuǎn)移與Twist在腫瘤細(xì)胞內(nèi)陽性表達(dá)不存在相關(guān)性(P0.05);Podoplanin在腫瘤細(xì)胞的陽性表達(dá)率和在脈管瘤栓內(nèi)陽性表達(dá)率分別為77.1%和65.7%,無顯著差異(P0.05)。Twist在腫瘤細(xì)胞陽性表達(dá)率和在脈管瘤栓內(nèi)陽性表達(dá)率分別為74.3%和71.4%,其差異無統(tǒng)計(jì)學(xué)意義(P0.05);Podoplanin在脈管瘤栓陽性患者的淋巴管和血管內(nèi)表達(dá)分別為78.3%和69.6%,Twist在脈管瘤栓陽性患者的淋巴管和血管內(nèi)表達(dá)分別為56%和72%,均無顯著差異(P0.05)。結(jié)論:1、Podoplanin和Twist在腫瘤組織中陽性表達(dá)率顯著較正常組織高。2、脈管瘤栓陽性的食管鱗癌患者和淋巴結(jié)轉(zhuǎn)移陽性的食管鱗癌患者腫瘤細(xì)胞內(nèi)Podoplanin陽性表達(dá)率明顯較高,說明Podoplanin在腫瘤細(xì)胞內(nèi)陽性表達(dá)與食管鱗癌患者出現(xiàn)脈管瘤栓和淋巴結(jié)發(fā)生轉(zhuǎn)移存在相關(guān)性;Podoplanin在腫瘤細(xì)胞內(nèi)的陽性表達(dá)與食管鱗癌患者年齡、性別、腫瘤浸潤(rùn)深度、腫瘤分化程度之間不存在相關(guān)性;食管鱗癌患者腫瘤細(xì)胞內(nèi)Podoplanin陽性表達(dá)組無病生存期明顯較陰性表達(dá)組短。臨床上可將Podoplanin的陽性表達(dá)作為判斷食管鱗癌患者預(yù)后的重要參考指標(biāo)。3、本實(shí)驗(yàn)中Twist在腫瘤細(xì)胞內(nèi)的表達(dá)與食管鱗癌患者的臨床病理特征和無病生存期之間無明顯相關(guān)性4、Podoplanin和Twist在腫瘤細(xì)胞內(nèi)和脈管瘤栓內(nèi)的表達(dá)率具有一致性,在血管瘤栓和淋巴管瘤栓內(nèi)的表達(dá)無選擇性,提示Podoplanin陽性表達(dá)率高的患者腫瘤侵襲性較強(qiáng)。
[Abstract]:Objective: it has been more and more attention of scholars and research vessel in patients with esophageal squamous cell carcinoma tumor thrombus of patients with esophageal squamous cell carcinoma patients. The emergence of the pathological phenomenon of vascular tumor thrombus in patients with esophageal squamous cell carcinoma within the tumor may be related to themselves with the invasive and metastatic characteristics of two kinds of the existing research results have been confirmed. Podoplanin and Twist mediated tumor metastasis and invasion of tumor and enhance the role played a very important effect in the process of tumor invasion and metastasis. This study was to investigate the expression of Podoplanin and Twist in esophageal squamous cell carcinoma, analysis of the relationship between the two kinds of tumor thrombus in patients with esophageal squamous cell carcinoma and the expression of vascular within, and further analysis of its expression and lymph node metastasis, tumor differentiation and the relationship between the clinical characteristics and prognosis of patients with esophageal squamous cell carcinoma patients, exploring the possible influence The risk factors, and to provide reference for the clinical treatment of these patients, in order to reduce tumor recurrence and prolong disease-free survival time of patients with esophageal squamous cell carcinoma and overall survival time. Methods the Department of thoracic surgery, Tumor Hospital of Sichuan Province in a complete clinical and pathological data and follow-up records from June 2010 to June 2012. 70 cases of patients with esophageal squamous cell carcinoma (Lvsi positive patients with esophageal squamous cell carcinoma in 35 cases, 35 cases of Lvsi negative patients with esophageal squamous cell carcinoma) postoperative pathological specimens by immunohistochemistry, SP staining were observed under microscope. Podoplanin and Twist two proteins in different parts, namely the expression of tumor tissue and tumor thrombus in during the same period, and in normal esophageal tissues of 70 patients were compared, analysis of 1, whether in the tumor tissues and normal tissues there were differences between the two proteins; 2 of the two proteins in tumor cells The relationship between the expression of tumor thrombus in patients with vascular, and further analysis of the expression of gender and age, and the depth of tumor invasion (T staging), tumor differentiation, lymph node metastasis, the relationship between these clinicopathological features; 3, two proteins in tumor cells and vascular invasion are consistent; 4, two kinds of protein in vascular tumor thrombus and expression of lymphatic tumor emboli in whether selective.5, tumor recurrence (i.e. disease-free survival) and the expression of the two proteins, tumor thrombus appeared in the vasculature, between the lymph node metastasis of these risk factors. Results: the positive expression rate of Podoplanin was 34.2% in normal esophageal tissues, the positive expression of Podoplanin in tumor tissues was 62.8%, significantly differences between the two groups (P0.05); the positive expression rate of twist was 42.9% in normal tissue, the positive expression rate of twist was 77.1% in tumor tissue, the two group also have significant difference (P0.05) pulse. Vessel tumor embolus in patients with esophageal squamous cell carcinoma cells Podoplanin positive rate of 77.1%, Lvsi negative patients with esophageal squamous cell carcinoma cells in the Podoplanin positive rate was 48.6%, the difference was statistically significant (P0.05). The lymph node metastasis of tumor in patients with esophageal squamous cell carcinoma cells in the Podoplanin positive rate was 71.9%, the tumor lymph node negative metastasis in patients with esophageal squamous cell carcinoma cells the positive rate of Podoplanin was 23.1%, the difference was statistically significant (P0.05). The tumor cells in Podoplanin negative patients with esophageal squamous cell carcinoma average disease-free survival was 15.2 months, patients with esophageal squamous cell carcinoma was significantly higher than that of tumor cells in Podoplanin positive (P0.05) in patients with esophageal squamous cell carcinoma. Age, gender, tumor invasion depth, there is no correlation between the expression of tumor the degree of differentiation and Podoplanin in tumor cells (P0.05); the expression rate of twist was 74.3% in Lvsi positive patients with esophageal squamous cell carcinoma cells, The expression rate of 80% twist Lvsi negative patients with esophageal squamous cell carcinoma cells, differential expression of twist between the two groups was not statistically significant (P0.05); patients with esophageal squamous cell carcinoma cells in twist negative expression group average disease-free survival was 8.3 months, with no significant difference between tumor cells in patients with esophageal squamous cell carcinoma (twist positive expression group P0.05); age, gender of patients with esophageal squamous cell carcinoma, tumor invasion, tumor differentiation, lymph node metastasis and the expression of Twist in tumor cells (P0.05); there is no correlation between the positive expression of Podoplanin in tumor cell rate and tumor thrombus in the vascular in the positive expression rates were 77.1% and 65.7%, no significant difference (P0.05.Twist) and rate of tumor thrombus in the vascular in the positive expression rates were 74.3% and 71.4% positive expression in tumor cells, the difference was not statistically significant (P0.05); Podoplanin in Lvsi positive patients with lymphatic And the intravascular level were 78.3% and 69.6%, Twist in Lvsi positive patients with lymphatic and vascular expression were 56% and 72%, there was no significant difference (P0.05). Conclusion: 1, Podoplanin and Twist in tumor tissues was significantly positive expression rate of.2 was higher than that in normal tissues, tumor thrombus positive in patients with esophageal squamous cell carcinoma and lymph node metastasis was significantly higher in Podoplanin positive expression rate of tumor in patients with esophageal squamous cell carcinoma cells with positive Podoplanin expression in esophageal squamous cell carcinoma and tumor cells in patients with vascular invasion and lymph node metastasis are related; the positive expression of Podoplanin in tumor cell and esophageal squamous cell carcinoma patients with age, sex, tumor the depth of invasion, there was no correlation between the degree of tumor differentiation; the positive expression of patients with esophageal squamous cell carcinoma cells in Podoplanin group was significantly higher than disease-free survival in negative group clinical short. The positive expression of Podoplanin as an important reference index for judging the prognosis of.3 patients with esophageal squamous cell carcinoma, between the clinical and pathological features of the expression of Twist in tumor cell and esophageal squamous cell carcinoma patients and disease free survival was no significant correlation between the 4, the expression of Podoplanin and Twist in tumor cells and tumor thrombus in rate consistency in vascular tumor thrombus and expression of lymphatic tumor thrombus in non selective, suggesting that the positive expression rate of Podoplanin in patients with high tumor invasion is stronger.

【學(xué)位授予單位】：四川醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R735.1

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