卵巢肿瘤中癌基因 nm23Hl,c-erbB-2,ras 和 p53 的蛋白表达与腹膜后淋巴结转移关系的研究

目的本研究旨在结合腹膜后淋巴结切除术，探讨癌蛋白ｎｍ２３Ｈ１，ｐ１８５，ｐ２１，ｐ５３在卵巢癌中的表达与卵巢癌腹膜后淋巴转移（ＬＮＭ）的关系。方法采用免疫组化方法测定石腊包埋标本中ｎｍ２３Ｈ１，ｐ１８５，ｐ２１和ｐ５３的表达，单因素、多因素分析它们的表达与淋巴结转移关系。结果在３１例（３１．６％）患者中ｎｍ２３Ｈ１蛋白表达阳性；ｐ２１的表达与组织分化程度及残留癌相关。病理证实４９例（５５．１％）有淋巴结转移；ｎｍ２３Ｈ１蛋白表达阳性的ＬＮＭ率低（３５．７％ｖｓ６３．９％，Ｐ＝０．０１２）；ｐ２１表达与ＬＮＭ正相关（Ｐ＜０．００１）；ｐ１８５（～）病例ＬＮＭ率（６４．４％）高于ｐ１８５（＋）或ｐ１８５（－）的转移率（４５．９％），但差异无统计学意义；ｐ５３表达与ＬＮＭ无关。与ＬＮＭ相关的临床因素是伴有腹水、组织分化不良、残留灶和分期晚。经Ｌｏｇｉｓｔｉｃ回归多因素分析，影响淋巴结转移的独立危险因素是ｎｍ２３Ｈ１蛋白阴性表达，ｐ２１的阳性表达、有残留灶和分化差。结论在卵巢恶性肿瘤中，ｎｍ２３Ｈ１蛋白和ｐ２１的表达对腹膜后淋巴结转移有独立的联合作用，而ｐ１８５和ｐ５３的表达则无关。

ONCOPROTEINS OF nm23H1,C erbB2,p53 AND ras GENES IN OVARIAN NEOPLASMS:SIGNIFICANCE IN PREDICTING RETROPE RITONEAL LYMPH NODE METASTASIS

Objective: To determine the relationship between oncoproteins of nm23H1 p185,p53,p21 and retroperiteal lymph node metastasis (LNM) in primary ovarian neoplasms. Methods:The expression of nm23H1,p185,p53,p21 was investigated by immunohistochemical technique in formalin fixed paraffin embedded specimens from 89 patients with primary ovarian malignancy. Results: 31/89 specimens (31 6%) showed immunopositive staining for nm23H. Elevated expression of p21 was associated with poor histological grade and bigger size of residual tumor( P <0 05). 49/89 patients (55 1%) were found to have LNM. LNM rate was significantly decreased in pateints with positive nm23H1 expression (35 7% vs 63 9%, P =0 012).The incidence of LNM was strongly correlates with p21 expression (71 7% vs 30 6%, P <0 01).Multivariate analysis showed that the independent risk factors for LNM were nm23H1 negative and p21 positive expression,as well as poor differentiation and presence of residual tumor. Conclusions: Oncoprotein of nm23H1 and p21 but not p185 and p53, may independently regulate the LNM process in ovarian cancer.