胃癌中p27Kip1、p53表达与其浸润、转移和预后的关系

目的研究胃癌组织中p27Kip1和p53的表达与胃癌浸润、转移和预后的关系。方法用免疫组化(二步法)检测100例胃癌组织中的p27Kip1蛋白和p53蛋白的表达。结果100例胃癌组织中p27Kip1和p53蛋白阳性表达率分别为44%和49%。在胃癌深部浸润组、淋巴结转移组和5年内死亡组中p27Kip1呈显著低表达(P<0.05);在胃癌淋巴结转移组和5年内死亡组中p53呈显著高表达(P<0.05)。经单变量分析结果显示p27Kip1高表达组5年生存率为70.59%,显著高于低表达组54.55%,和阴性组26%;p53高表达组5年生存率为19.23%,显著低于低表达组43.75%和阴性组53.19%。多变量Cox回归模型分析显示p27Kip1、p53均是独立的预后指标,但p27Kip1表达对患者预后的相对危险度(RR=3.06)显著大于p53表达的相对危险度(RR=2.33,P<0.01)。结论p27Kip1低表达与p53高表达的癌细胞常更能浸润与转移,使患者生存率明显降低。p27Kip1和p53是胃癌预后的独立指标,其中p27Kip1表达评估胃癌预后的作用优于p53。

The Relationship between the Expression of p27Kip1, p53 and the Infiltration, Metastasis and Prognosis in Gastric Carcinoma

Objective: To study the relationship between the expression of p27Kip1 and p53, and the infiltration, metastasis and prognosis in gastric carcinoma. Methods: The expression of p27Kip1 and p53 at protein level was determined by immunohistochemical assay (two-step method) in 100 cases of gastric carcinoma. Results: Of the 100 cases, the positive rate of p27Kip1 and p53 expressions were 44% and 49%, respectively. In the group of gastric carcinomas with deep infiltration (infiltration group), lymph nodes metastasis group (metastasis group) and death-within-5-years group (death group), the expression of p27Kip1 was statistically lower (_P<0.05). In the metastasis group and death group, the expression of p53 was significantly higher (P<0.05). The results of the monovariate analysis revealed that the 5-year survival rate of the high p27Kip1 expression group was 70.59%, which is higher than those of the low p27Kip1 expression group (54.55%) and the negative experession group (26%). The 5-year survival rate of the high p53 expression group was 19.23%, which was lower than those of the p53 low expression group (43.75%) and the negative group (53.19%). Cox multivariate analysis showed that p27Kip1, like p53, was an independent prognostic index. But p27Klpl protein expression was a stronger independent survival predictor (RR=3.06) than p53 expression (RR=2.33). Conclusion: The low expression of p27Kip1 and the high expression of p53 reflected the more frequent invasion and metastasis, which resulted in the reduced survival of patients. As an independent markers of the gastric carcinoma, the expression of p27Kip1 is more useful than that of p53 in the prognosis prediction of gastric carcinoma.