结直肠癌临床及病理免疫组织化学多因素分析

目的探讨结直肠癌的生长方式,间质淋巴细胞浸润,Ｄｕｋｅｓ分期,ｐ５３和ｃ－ｅｒｂＢ－２蛋白,增殖细胞核抗原（ＰＣＮＡ）增殖指数,Ｐ２１蛋白,上皮生长因子受体（ＥＧＦＲ）、间质纤维组织增生及组织学类型１０种因素对患者预后的影响。方法运用Ｃｏｘ模型对６８例结直肠癌上述十种因素与预后的关系进行分析。结果单因素分析显示上述前六种因素对患者的预后有影响;经多因素分析显示Ｐ２１和ｃ－ｅｒｂＢ－２蛋白表达情况,Ｄｕｋｅｓ分期以及ＰＣＮＡ指数与病人预后有关,两种癌基因蛋白共同表达时病人的死亡相对危险度更高,ＤｕｋｅｓＡ期Ｐ２１或ｃ－ｅｒｂＢ－２蛋白阳性病人的死亡相对危险度比ＤｕｋｅｓＢ期相应蛋白阴性的病人高。结论Ｐ２１、ｃ－ｅｒｂＢ－２蛋白、ＰＣＮＡ增殖指数及Ｄｕｋｅｓ分期可作为估计结直肠癌患者预后的独立指标,Ｐ２１及ｃ－ｅｒｂＢ－２蛋白同时表达是预后更差的指征。

Multivariate analysis of clinicopathological and immunohistochemical factors in colorectal carcinomas

Objective To determine the effect of clinicopathological and immunohistochemical factor on the prognosis of colorectal carcinoma. Methods The Cox model was used in a series of 68 colorectal carcinomas to study ten prognostic factors. These factors included tumor growth, stromal lymphocyte infiltration and fibrous tissue proliferation, degree of differenciation, Dukes stage, p53 protein, c erbB 2 protein, P21 protein, PCNA proliferation index and EGFR. Results Monovariate analysis showed that tumor growth, stromal lymphocyte response, Dukes stage, p53, c erbB 2 protein and PCNA index influenced prognosis significantly; multivariate analysis revealed 4 significant prognostic factors: P21, c erbB 2 protein, Dukes stage and PCNA index. The relative risk (RR) for mortality was high in patients having P21 and c erbB 2 co expression. The RR of P21 and c erbB 2 protein positive patients in Dukes A stage was higher than that of P21 and c erbB 2 protein negative patients in Dukes B stage. Conclusions P21, c erbB 2 protein, PCNA index and Dukes stage were independent predictors of survival. The prognosis of patients with P21 and c erbB 2 protein co expression was worse than in patients without this co expression.