本文選題：胃癌　切入點：惡性程度　出處：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討免疫組化標(biāo)記物VEGFR2、HER2及TP在胃癌組織中的表達(dá)水平與胃癌惡性程度的關(guān)系,以及三者聯(lián)合檢測對胃癌惡性程度評估的意義和臨床應(yīng)用價值。方法:回顧性分析大連醫(yī)科大學(xué)附屬第二醫(yī)院胃腸外科2015年1月至2016年10月收治的169例胃癌患者的免疫組化標(biāo)記物VEGFR2、HER2、TP的檢測結(jié)果及相關(guān)臨床病理資料(年齡、性別、腫瘤大小、腫瘤部位、分化程度、浸潤深度、TNM分期、有無區(qū)域淋巴結(jié)轉(zhuǎn)移、有無遠(yuǎn)處轉(zhuǎn)移、有無脈管及神經(jīng)侵犯)。運用SPSS17.0軟件系統(tǒng)進(jìn)行統(tǒng)計分析,選用秩和檢驗(Mann-Whitney test和Kruskal-Wallis test)來分析VEGFR2、HER2、TP表達(dá)水平與患者臨床病理資料間的關(guān)系;所涉及相關(guān)性分析均選用Spearman等級相關(guān)分析,根據(jù)統(tǒng)計分析結(jié)果來探討以上三項免疫組化標(biāo)記物的表達(dá)水平與胃癌惡性程度的關(guān)系,以及三者聯(lián)合檢測對胃癌惡性程度評估的意義及臨床應(yīng)用價值。結(jié)果:胃癌組織中VEGFR2的高表達(dá)與胃癌患者的浸潤深度(p=0.013)、TNM分期(p=0.019)、區(qū)域淋巴結(jié)轉(zhuǎn)移(p=0.007)、脈管侵犯(p=0.002)有關(guān),并且VEGFR2的表達(dá)水平與浸潤深度(r=0.217,p=0.005)及TNM分期成正相關(guān)(r=0.237,p=0.002);而與患者性別、年齡、腫瘤大小、腫瘤部位、分化程度及有無遠(yuǎn)處轉(zhuǎn)移和神經(jīng)侵犯無關(guān)(p0.05)。胃癌組織中HER2的高表達(dá)僅與胃癌組織的分化程度有關(guān)(p=0.001),且成負(fù)相關(guān)(r=-0.286,p0.001),而與患者的性別、年齡、腫瘤大小、腫瘤部位、浸潤深度、TNM分期及有無區(qū)域淋巴結(jié)轉(zhuǎn)移、遠(yuǎn)處轉(zhuǎn)移和脈管、神經(jīng)侵犯均無關(guān)(p0.05)。胃癌組織中TP的高表達(dá)與胃癌患者的浸潤深度(p=0.016)、淋巴結(jié)轉(zhuǎn)移(p=0.012)、TNM分期(p=0.010)、遠(yuǎn)處轉(zhuǎn)移(p=0.019)有關(guān),并且TP的表達(dá)水平與浸潤深度(r=0.214,p=0.005)、TNM分期(r=0.196,p=0.011)成正相關(guān);而與患者性別、年齡、腫瘤大小、腫瘤部位、分化程度及有無脈管和神經(jīng)侵犯無關(guān)(p0.05)。VEGFR2與TP的表達(dá)呈正相關(guān)(r=0.200,p=0.009);而HER2與VEGFR2的表達(dá),HER2與TP的表達(dá)均無顯著相關(guān)性(p0.05)。結(jié)論:VEGFR2的高表達(dá)與胃癌浸潤深度、TNM分期、淋巴結(jié)轉(zhuǎn)移、脈管侵犯有關(guān),可能是評價胃癌惡性程度重要指標(biāo),與胃癌惡性程度呈正相關(guān)。HER2的高表達(dá)與胃癌組織分化程度成負(fù)相關(guān),表明HER2的表達(dá)具有選擇性,HER2陽性的胃癌可能具有較低的惡性程度。TP的高表達(dá)與胃癌浸潤深度、淋巴結(jié)轉(zhuǎn)移、TNM分期、遠(yuǎn)處轉(zhuǎn)移有關(guān),可能成為評價胃癌惡性程度的指標(biāo)之一,與胃癌惡性程度呈正相關(guān)。VEGFR2與TP的表達(dá)呈正相關(guān);而HER2與VEGFR2、TP的表達(dá)無顯著相關(guān)性,表明HER2可能不直接參與胃癌的血管生成,不會增加胃癌惡性程度;而VEGFR2、TP可能在胃癌血管生成及加重胃癌惡性程度方面具有協(xié)同作用。三者聯(lián)合檢測對胃癌的惡性程度評估具有重要價值,并對臨床靶向藥物及化療藥物的選擇具有指導(dǎo)意義。
[Abstract]:Objective: to investigate the relationship between the expression of VEGF FR2HER2 and TP in gastric carcinoma and the malignant degree of gastric cancer. The significance and clinical value of combined detection in the evaluation of malignant degree of gastric cancer methods: a retrospective analysis of 169 patients with gastric cancer admitted from January 2015 to October 2016 in the second affiliated Hospital of Dalian Medical University. The immunohistochemical marker VEGFR2HER2TP and its clinicopathological data (age, age, age). Sex, tumor size, tumor location, differentiation degree, depth of invasion, TNM staging, regional lymph node metastasis, distant metastasis, vascular and nerve invasion were analyzed with SPSS17.0 software system. Mann-Whitney test and Kruskal-Wallis testwere used to analyze the relationship between the expression of VEGFR2HER2TP and the clinicopathological data of the patients, and Spearman rank correlation analysis was used to analyze the correlation. According to the results of statistical analysis, the relationship between the expression of the above three immunohistochemical markers and the malignant degree of gastric cancer was studied. Results: the high expression of VEGFR2 in gastric cancer was related to the depth of invasion of gastric cancer, the regional lymph node metastasis p0.007, and the vascular invasion of p0.002). The expression level of VEGFR2 was positively correlated with the depth of invasion (0.217p0. 005) and the TNM stage, and with sex, age, tumor size and tumor location. The high expression of HER2 in gastric cancer was only related to the differentiation degree of gastric cancer, and was negatively correlated with the sex, age, tumor size, tumor location, and negatively correlated with the patient's sex, age, tumor size, tumor location, and negative correlation with the degree of differentiation. TNM stage and regional lymph node metastasis, distant metastasis, vascular invasion and nerve invasion were not related to the expression of TP in gastric cancer. The high expression of TP was related to the depth of invasion of gastric cancer patients (p0.016), lymph node metastasis (p0.012), TNM staging (p0.010) and distant metastasis (p0.019). The expression level of TP was positively correlated with the depth of invasion (0.214p) and TNM stage (0.196 p0.011), but was positively correlated with the patient's sex, age, tumor size and tumor location. The expression of VEGF R2 and TP was positively correlated with the expression of TP, while the expression of HER2 and VEGFR2 had no significant correlation with the expression of TP. Conclusion the high expression of VEGFR2 is associated with the stage of invasion depth of gastric carcinoma, lymph node metastasis, and the expression of HER2 and TP is not significantly correlated with the degree of differentiation and the presence of vascular and nerve invasion. Vascular invasion may be an important index to evaluate the malignant degree of gastric cancer, and the high expression of HER2 is negatively correlated with the degree of differentiation of gastric cancer. The results suggest that the high expression of HER2 may be associated with the depth of invasion, lymph node metastasis and distant metastasis of gastric cancer, which may be one of the indicators to evaluate the malignant degree of gastric cancer. There was a positive correlation between VEGF R2 and TP expression in gastric cancer, but there was no significant correlation between HER2 and VEGF R2TP expression, indicating that HER2 might not directly participate in angiogenesis of gastric cancer and would not increase the malignant degree of gastric cancer. VEGFR2TP may play a synergistic role in angiogenesis and the degree of malignancy of gastric cancer. The combined detection of the three may be of great value in evaluating the malignancy of gastric cancer, and also of guiding significance in the selection of targeted drugs and chemotherapeutic drugs.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.2

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