Survivin、COX-2和VEGF在胃癌中的表达及其与预后的意义

目的研究生存素(Survivin)、环氧合酶-2(COX-2)和血管内皮生长因子(VEGF)在胃癌组织中的表达,探讨它们表达的关系及其与胃癌预后的关系。方法选取淮南东方医院集团总医院1992~2002年10年间行根治性手术治疗,临床、病理和随访资料齐全的胃癌患者65例,应用免疫组化S-P技术,检测Survivin、COX-2和VEGF在胃癌组织中表达。结果早期胃癌的5年生存率为95.2%(20/21),中期胃癌的5年生存率为63.6%(7/11)。中期胃癌组Survivin阳性表达高于早期胃癌组(73.6%vs 66.7%,P<0.05),其VEGF阳性表达和微血管密度(MVD)平均值高于早期胃癌组(P<0.05)。Survivin和COX-2在慢性萎缩性胃炎中的表达明显低于不典型增生者(P<0.05),在癌组织中的表达明显高于非癌组织(P<0.05)。胃癌组中的VEGF阳性表达率和MVD平均值均明显高于非癌组,且与胃癌浸润深度有关(P<0.05)。胃癌中Survivin、VEGF阳性表达的MVD值显著高于Survivin、VEGF阴性表达者(P<0.05);Survivin、COX-2、VEGF及MVD值与胃癌淋巴结转移、血管浸润均密切相关(P<0.05);Survivin、COX-2阳性表达及VEGF阳性表达者5年生存率明显低于阴性或低表达者(P<0.05)。多因素分析显示,淋巴结转移、浸润深度、Survivin表达、VEGF表达均为胃癌独立的预后因素。结论Survivin、COX-2、VEGF与胃癌的生长和浸润转移关系密切,可以作为反映胃癌生物学行为和判断预后的有效指标。

Expression of Survivin, Cyclooxygenase-2 and Vascular Endothelial Growth Factor and Their Prognostic Significance in Human Gastric Carcinoma

Objective To investigate the expression of Survivin,cyclooxygenase-2(COX-2),and vascular endothelial growth factor(VEGF)in gastric carcinoma,and the relationship among expression of Survivin,COX-2 and VEGF,as well as their prognostic significance.Methods 65patients with early and middle stage of gastric carcinoma who underwent surgical resection during 1992 and 2002 were tollowed up.Expression ofsurvivin,COX-2 and VEGF were examined by S-P immunohistochemistry in 65 archival paraffin-embedded tissue specimins and controlgroups.Results 5-years survival rates of early and middle stage of gastric carcinoma were 95.2 and63.6%,respectively.Amonggastric carcinoma inour study,Survivin expression rate in middle stage of gastric carcinoma group was higher than that in early gastric carcinoma(73.6% vs66.7%,P<0.05).Expression of VEGF and MVD value in middle stage of gastric carcinoma was significantly higher than that in early gastric carcinoma(P<0.05).Expression of Survivin and COX-2 in mucosal atypical hyperplasia was significantly higher than that in chronic atrophic gastritis(P<0.05).Su-rvivin and COX-2 levels in carcinoma tissue were significantly higher than paired noncancerous spcimens(P<0.05).Expression of VEGF and mi-crovssel density(MVD) value in carcinoma tissue was significantly higher than those in noncancerous specimens(P<0.05).The MVD value insurvivin( ) group and VEGF( ) group was much higher than that in survivin(-) group and VEGF(-) group(P<0.05).Expression ofSurvivin,COX-2,VEGF and the MVD value were highly correlated with lymph node metastasis and vascular invasion(P<0.05).The 5 years sur-vival rate in the patients with Survivin,COX-2,VEGF expression was much lower than the rate in those patients without Survivin,COX-2,VEGF ex-pression(P<0.05).Multivariate analysis indicated that lymph node metastasis,depth of invasion,Survivin expression and VEGF expression wereall independent prognostic factors of gastric carcinoma.Conclusion Expression of Survivin,COX-2 and VEGF may serve as the fairly well prog-nostic factors to indicate the biologic behavior and prognosis in gastric carcinoma.