胃肠间质瘤中ETV1的表达及意义

目的 探讨ETV1蛋白在胃肠间质瘤(GIST)不同临床病理因素下的表达情况及对预后的影响.方法 通过回顾性分析行外科治疗的115例GIST患者.采用病理形态、免疫组织化学,结合基因测序获得病理确诊,分析GIST的ETV1、CD117、DOG-1及CD34蛋白表达情况,采用Kaplan-Meier法绘制生存曲线,并进行单因素和多因素分析预后相关因素.结果 115例GIST病例中,ETV1、CD117、DOG-1及CD34蛋白阳性率分别为92.2%、89.6%、92.2%、84.2%,ETV1与CD117、DOG-1及CD34蛋白之间的表达率差异无统计学意义(P>0.05),亦无相关性(P>0.05).ETV1蛋白在CD117阴性GIST中有较高表达(83.3%),高于DOG-1和CD34蛋白,但表达差异无统计学意义(P>0.05),而野生型GIST中ETV1蛋白表达率66.7%,高于DOG-1和CD34蛋白,差异有统计学意义(P<0.05).ETV1在不同的核分裂及NIH危险度分级GIST患者中的表达差异有统计学意义(P<0.05).对于根治切除的GIST患者,不同的ETV1表达和NIH危险度分级,其3年无病生存率差异有统计学意义(P<0.05),ETV1阳性表达的患者较阴性表达的患者复发率下降(14.1% vs 55.6%,P=0.008),且有更高的3年无病生存率(80% vs 56%,P=0.047).随访时间5~108个月,中位随访时间为31个月,患者的3、5年生存率依次为76%、58%,根治切除患者3年生存率为84%,5年生存率为70%,3年无病生存率为77%.生存分析显示肿瘤大小、NIH危险度分级、手术方式、转移情况是影响GlST预后的因素,而是否发生转移是独立预后因素.结论 ETV1蛋白在GIST中具有较高的阳性表达率,对于野生型GIST有补充诊断作用,且ETV1的表达可能作为GIST根治切除术后患者的3年无病生存率预后评估指标.

The significance and expression of ETV1 in Gastrointestinal stromal tumor

Objective To investigate the expression of ETV1 protein in gastrointestinal stromal tumor (GIST) with different clinical pathologic factors and its prognostic significance in GIST.Methods One-hundred and fifteen cases of GIST patients, who were treated with surgical resection between January 2005 and December 2005 in the People's Hospital of Guangxi Zhuang Autonomous Region, were retrospectively analyzed.Using immunohistochemistry (IHC) combined with gene sequencing, ETV1, CD117, DOG-1, and CD34 protein expression were measured.Survival analysis was performed by survival curve.Univariate survival analysis and multivariate survival analysis were also performed.Results The ETV1, CD117, CD34 and DOG-1 positive rates were 92.2%, 89.6%, 92.2% and 84.2%, respectively;and there was no significant difference among their expression, nor significant correlation was revealed.ETV1 protein had higher expression (83.3%) in CD117 negative GIST than DOG-1 and CD34 proteins, but there was no significant difference (P>0.05).In Wild-type GIST, ETV1 was significantly higher expressed (66.7%) than DOG-1 and CD34 protein (P<0.05).There was significant difference in expression of ETV1 among different nuclear fission and NIH risk grades (P<0.05).For patients with radical resection, significant differences in the 3-year disease-free survival rate were revealed among different expression of ETV1 and NIH risk grades.Patients with positive ETV1 expression had significantly lower recurrence rate (14.1% vs.55.6%, P<0.05) and higher 3-year disease-free survival rate (80% vs.56%, P<0.05).Conclusion ETV1 protein has high expression rate in various GIST, providing good supplement in diagnosis of wild type GIST.For patients with radical resection, ETV1 promises to be a prognostic factor of 3-year disease-free survival.