本文選題：賁門癌 + 預(yù)后�。� 參考：《吉林大學(xué)》2016年博士論文

【摘要】：目的:過去幾十年,胃癌的總體發(fā)病率逐漸下降,但其中賁門癌的發(fā)病率卻逐年上升,手術(shù)治療是最常見的治療方法。為了徹底清除腫瘤細(xì)胞及淋巴結(jié),臨床手術(shù)切除時(shí)通常一起切除脾臟,但是脾切除對(duì)患者生存率的影響仍存在爭(zhēng)議。本研究分析聯(lián)合脾臟切除術(shù)在賁門癌手術(shù)治療中的作用,同時(shí)研究賁門癌組織中VEGF、MMP-9和E-cadherin等相關(guān)標(biāo)志物蛋白的表達(dá),探討聯(lián)合脾臟切除在外科手術(shù)治療賁門癌中的價(jià)值和意義以及VEGF、MMP-9和E-cadherin的表達(dá)與賁門癌生物學(xué)行為之間的關(guān)系,為賁門癌的臨床診斷和治療提供新的思路和理論依據(jù)。方法:回顧性分析2003年9月至2010年12月本院收治的348名胃賁門癌患者,其中105名患者進(jìn)行全胃切除結(jié)合脾切除術(shù)(脾切除組),243名患者只是進(jìn)行單純的全胃切除手術(shù)(脾保留組)。分析比較兩組患者的術(shù)后生存率及預(yù)后因素,并采用免疫組化法檢測(cè)患者賁門癌組織及癌旁組織中的VEGF、MMP-9和Ecadherin蛋白的表達(dá)。結(jié)果:1、脾切除組患者5年生存率為20.8%,脾保留組患者5年生存率為30.5%,兩組相比較差異具有統(tǒng)計(jì)學(xué)意義。2、多變量分析結(jié)果顯示,腫瘤浸潤(rùn)深度和淋巴結(jié)轉(zhuǎn)移是賁門癌患者的重要預(yù)后因素(P0.01),而脾切除不是賁門癌患者的獨(dú)立預(yù)后因素(P=0.206)。3、賁門癌組織中VEGF、MMP-9和E-cadherin蛋白陽(yáng)性表達(dá)率分別為57.31%、60.25%和21.23%,癌旁組織中三個(gè)蛋白的表達(dá)率分別為11.41%、13.24%和51.74%,三者的表達(dá)在癌組織與癌旁組織中均具有統(tǒng)計(jì)學(xué)差異,P值均小于0.01。4、VEGF、MMP-9和E-cadherin的表達(dá)與腫瘤浸潤(rùn)深度和淋巴結(jié)轉(zhuǎn)移與否有關(guān)。VEGF和MMP-9的表達(dá)隨著淋巴結(jié)轉(zhuǎn)移和腫瘤浸潤(rùn)深度的增加逐漸增強(qiáng),而E-cadherin的表達(dá)則與之相反,隨著淋巴結(jié)轉(zhuǎn)移和腫瘤浸潤(rùn)深度的增加逐漸降低。5、VEGF、MMP-9和E-cadherin的表達(dá)與患者5年生存率相關(guān)。VEGF和MMP-9表達(dá)越高,患者5年生存率越低(P=0.012,0.015),而E-cadherin表達(dá)越高,患者5年生存率越高(P=0.006)。6、線性相關(guān)分析表明,VEGF與MMP-9呈正相關(guān)(r=1.357,P0.05),與E-cadherin呈負(fù)相關(guān)(r=-3.241,P0.05,MMP-9與E-cadherin呈負(fù)相關(guān)(r=-2.563,P0.05)。結(jié)論:1、脾切除術(shù)不適合所有類型的賁門癌患者,適合浸潤(rùn)深、淋巴結(jié)轉(zhuǎn)移多的患者。腫瘤浸潤(rùn)深度和淋巴結(jié)轉(zhuǎn)移是賁門癌患者重要預(yù)后因素,而脾切除不是賁門癌患者的獨(dú)立預(yù)后因素。2、VEGF、E-cadherin和MMP-9在賁門癌的發(fā)生發(fā)展和轉(zhuǎn)移過程中起重要作用,三者的異常表達(dá)可作為判斷患者預(yù)后的重要生物學(xué)指標(biāo)。
[Abstract]:Objective: in the past few decades, the overall incidence of gastric cancer has gradually decreased, but the incidence of cardiac cancer has increased year by year. Surgical treatment is the most common treatment. In order to completely remove tumor cells and lymph nodes, splenectomy is usually performed together, but the effect of splenectomy on survival rate remains controversial. The purpose of this study was to investigate the role of combined splenectomy in the surgical treatment of cardiac carcinoma, and to study the expression of VEGF MMP-9 and E-cadherin in gastric cardia carcinoma. To explore the value and significance of combined splenectomy in the surgical treatment of cardiac carcinoma and the relationship between the expression of VEGF MMP-9 and E-cadherin and the biological behavior of gastric cardia carcinoma, and to provide new ideas and theoretical basis for the clinical diagnosis and treatment of cardiac carcinoma. Methods: from September 2003 to December 2010, 348 patients with gastric cardia carcinoma were retrospectively analyzed. 105 patients were treated with total gastrectomy combined with splenectomy. The survival rate and prognostic factors of the two groups were analyzed and the expression of VEGF MMP-9 and Ecadherin protein in cardiac carcinoma and adjacent tissues were detected by immunohistochemical method. Results the 5-year survival rate was 20.8in the splenectomy group and 30.5 in the splenectomy group. The difference between the two groups was statistically significant. The depth of tumor invasion and lymph node metastasis were important prognostic factors for cardiac cancer patients (P 0.01), while splenectomy was not an independent prognostic factor in cardiac cancer patients. The positive expression rates of VEGF MMP-9 and E-cadherin protein were 57.31% and 21.23% in gastric cardia carcinoma tissues, respectively. The positive rates of VEGF MMP-9 and E-cadherin protein were 21.23% and 21.23%, respectively, in gastric cardia carcinoma tissues, and splenectomy was not an independent prognostic factor in cardia cancer patients. The expression rates of three proteins in the tissue were 11.41% and 51.74%, respectively. The expression of the three proteins in cancer tissues and adjacent tissues was significantly different (P < 0.01.4%). The expression of VEGF and MMP-9 were related to the depth of tumor invasion and lymph node metastasis. With the increase of lymph node metastasis and depth of tumor invasion, On the contrary, the expression of E-cadherin decreased with the increase of lymph node metastasis and depth of tumor invasion. The higher the expression of VEGF and MMP-9 was, the lower the 5-year survival rate was, and the higher the expression of E-cadherin was, the lower the 5-year survival rate was. The 5-year survival rate was higher. The linear correlation analysis showed that there was a positive correlation between MMP-9 and MMP-9, and a negative correlation between MMP 9 and E-cadherin. ConclusionSplenectomy is not suitable for all types of cardiac cancer, but is suitable for patients with deep invasion and more lymph node metastasis. The depth of tumor invasion and lymph node metastasis are important prognostic factors in patients with cardiac carcinoma, while splenectomy is not an independent prognostic factor of cardiac carcinoma. 2VEGFU E-cadherin and MMP-9 play an important role in the development and metastasis of cardiac carcinoma. The abnormal expression of these three proteins can be used as an important biological index to judge the prognosis of patients.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R735.2

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