幕上星形细胞瘤PCNA和nm23-H1表达与相关预后因素分析

目的　探讨星形细胞瘤PCNA、nm2 3 H1表达与患者的临床特征和MRI征象之间的关系 ,通过多因素分析筛选出影响星形细胞瘤患者预后的重要因素以指导临床治疗。方法　对随诊资料完整和病理诊断明确的术前行MRI平扫及增强检查、术后行放射治疗的 5 2例幕上星形细胞瘤患者的手术切除标本 ,采用SP免疫组织化学法检测其组织切片中PCNA及nm2 3 H1表达 ,结合患者的临床资料 ,进行相关分析和多因素分析。结果　星形细胞瘤PCNA表达水平在不同病理级别中差异有显著性意义 (P <0 .0 5 ) ,肿瘤组织的PCNA表达与瘤旁组织的表达差异有显著性意义 (P <0 .0 5 )。PCNA表达与星形细胞瘤患者生存率呈负相关 ,且PCNA表达与星形细胞瘤MRI征象中增强程度、最大横截面直径、信号不均匀性及瘤周水肿均明显相关 (P <0 .0 5 )。不同病理级别星形细胞瘤中 ,nm2 3 H1表达差异无显著性意义 (P >0 .0 5 ) ,但与瘤周正常组织的表达有差异。PCNA表达与nm2 3 H1表达无显著相关性 (P >0 .0 5 )。多因素分析显示影响星形细胞瘤患者生存率的主要因素有病理分级和PCNA表达水平。结论　PCNA表达水平可反映星形细胞瘤患者的预后情况 ,可间接推断瘤体的生物学特征和影像学表现 ,PCNA表达与病理分级结合 ,可作为有价值的监测指标。

Relationship between PCNA, nm23-H1 expression and prognostic factors in supratentorial astrocytoma

Objective To study the expression of proliferating cell nuclear antigen (PCNA), metastasis-related gene nm23-H1 in supratentorial astrocytomas, and analyze the prognostic factors and the relationship between PCNA expression, nm23-H1 expression and clinical, MRI features.Methods From November 1994 to December 1998, 52 pathologically proved astrocytoma patients with complete clinical data were analyzed. The expressions of PCNA and nm23-H1 were detected by streptabitin peroxidase (SP) immunohistochemical method. Clinical and MRI data were collected and analyzed by Cox proportional hazard model .Results There was a significant difference in the expressions of PCNA and nm23-H1 in the lesion and their adjacent tissues (P< 0.05 ).The expression of PCNA was associated with the survival rate and some MRI findings, but the nm23-H1 protein was not associated with the survival rate. There was no correlation between PCNA and nm23-H1 expressions. Tumor pathological grade and the PCNA expression were important prognostic factors for survival by Cox proportional hazard model analysis.Conclusions Expression of PCNA, correlating with the MRI findings, can predict the survival of the supratentorial astrocytoma. PCNA and pathological grade are valuable prognostic factors.