胰腺癌淋巴结转移与P53、Ki67表达及预后的关系

目的:探讨胰腺癌组织淋巴结转移及其与突变型P53、Ki67表达及患者预后的关系。方法:统计手术切除并作区域性淋巴结清扫的51例胰腺癌标本淋巴结分站转移情况,采用免疫组织化学方法检测胰腺癌组织中P53和Ki67的表达,分析淋巴结转移情况与P53、Ki67表达以及肿瘤直径和患者年龄、预后的关系。结果:51例胰腺癌中37倒有淋巴结转移(72.5%)。47例胰头癌中转移频率较高的淋巴结为14a组(40.4%)、13a组(38.3%)、13b组(31.0%)、8组(29.8%)。肿瘤直径、P53表达分级、Ki67增殖指数分级与淋巴结转移程度呈正相关(P<0.05)。随着Ki67增殖指数的升高胰腺癌组织中P53的表达呈上升趋势(P<0.01)。本组患者5年生存率为8.9%,淋巴结转移距离与患者生存期呈负相关(P<0.05)。结论:胰腺癌组织中突变型P53及Ki67表达升高,可能对肿瘤远距离淋巴结转移起协同促进作用。出现第1站以远的淋巴结转移均标志患者预后不良。

The Relationship between Regional Lymph Node Metastases and Expression of P53 and Ki67 in Pancrestic Carcinoma and its Prognostic Significance

Objective:To evaluate the regional lymph node metastases in pancreatic carcinoma and to investigate the relation- ship between the lymphatic metastasis and the expressions of mutant P53 and Ki67 and their association with the prognosis of patients.Methods:Fifty-one patients of pancreatic adenocarcinoma performed pancreatoduodenectomy and extended regional lymph node dissection were assessed for regional lymph node metastases,and were given accurate follow-up for one to five years.The expression of mutant P53 and Ki67 were detected by immunohistochemical staining in all cases of surgical speci- mens,and we analyzed the mutual relationship between local and distant lymph nodes extend and over expression of p53,Ki67 index,tumor size,patient age and survival.Results:Metastasis of the lymph nodes was found in 37 out of 51 specimen (72.5%).There is a higher ratio of metastasis to the group 14a,13a.13b and S lymph nodes in 47 pancreatic head carcinoma specimens.A significant correlation was observed between the extent of metastatic lymph nodes and tumor diameter,P53 grade,Ki67 index grade,however,no relation with patient age was found.Statistical analysis showed that P53 overexpression had a significant correlation with higher Ki67 index(P<0.01).Our study shows that the five year survival was 8.9%.Further- more.distant metastasis was associated significantly with a shorter median survival.Conclusion:Overexpression of P53 and Ki67 in pancreatic adenocarcinoma might corporately promote lymphatic distant metastasis.Patients with metastasis to lymph nodes group 1 have an unfavorable prognosis.