存活素和尿激酶型纤溶酶原激活剂联合检测对胰腺癌预后判断价值

目的 存活素(Survivin)和尿激酶型纤溶酶原激活剂(urokinase plasminogen activator,uPA)在胰腺癌侵袭转移过程中发挥重要作用.本研究通过联合检测Survivin和uPA在胰腺癌中的表达,探讨两者在评估胰腺癌预后的临床价值.方法 选取2000-01-01-2007 12-01兰州军区乌鲁木齐军区总医院肝胆外科手术切除的63例原发性胰腺癌组织作为样本.采用免疫组化法检测Survivin和uPA蛋白在胰腺癌组织中的表达,并分析其与胰腺癌患者临床病理特征和预后的相关性.结果 Survivin和uPA蛋白与患者分化程度(x2=20.607,P＜0.001;x2 =11.529,P=0.003)、TNM分期(x2 =8.679,P=0.034;x2 =15.166,P=0.002)及是否淋巴结转移(x2=5.377,P=0.020;x2 =10.101,P=0.001)均有关.Survivin与uPA的表达呈正相关(r=0.389,P=0.002).Kaplan-Meier生存曲线结果显示,Survivin(-)组患者1年累计生存率(86.7％)及中位生存期(21个月)均高于Survivin(+)组患者(22.0％,9个月),差异有统计学意义,x2 =29.893,P＜0.001.uPA(-)组患者1年累计生存率(90.0％)及中位生存期(18个月)均高于uPA(+)组患者(5.9％,9个月),差异有统计学意义,x2=41.495,P＜0.001.Survivin(-)/uPA(-)组患者术后生存期均高于其他组,差异有统计学意义,x2=52.453,P＜0.001.Cox多因素分析结果表明,淋巴结转移(P=0.018)、Survivin(P＜0.001)和uPA过表达(P＜0.001)是影响胰腺癌预后的独立相关因子.结论 在胰腺癌发生发展侵袭和转移过程中Survivin与uPA蛋白之间存在某种协同关系,联合检测两者的表达可能更确切反映胰腺癌的预后及作为淋巴结转移判断胰腺癌预后的补充.

Value of combined detection with Survivin and uPA in prognosis of pancreatic carcinoma

OBJECTIVE Survivin and uPA play important roles in the invasion and metastasis of pancreatic cancer.We performed this study to investigate the value of combined detection with Survivin and uPA in pancreatic carcinoma and its clinical significance as a prognostic factor.METHODS From January 1,2000 to December 1,2007,surgical resected cancer tissues and adjacent tissues of 63 patients with pancreatic cancer and their clinical data were recruited at Department of Pathology of Urumuqi General Hospital of Lanzhou Military Region.The expression of Survivin and uPA protein in pancreatic cancer tissues were detected by immunohistochemistry,and its relationship with clinicopathological features was analyzed.Chi-square test was performed for comparison of ratios between groups.Overall survival analysis of 63 patients after surgery was performed.RESULTS The expression of Survivin and uPA were significantly correlated with differentiation,TNM stages and lymph node metastasis(all P＜0.05)separately,and were not correlated with age,tumor location and tumor size (all P＞0.05).The expression of Survivin was positively correlated with the expression of uPA (r=0.389,P=0.002).Kaplan-Meier survival analysis showed that 1-year survival rate and median survivalof patients with Survivin(-),uPA(-) were significantly longer than that of the patients with Survivin(+) and uPA (+),respectively (x2 values were 29.893 and 41.495,P values were both ＜0.001).The survival time of patients with with Survivin (-)/uPA(-)was significantly longer than the others (x2 =52.453,P＜0.001).Lymph node metastasis (P =0.018),Survivin(P＜0.001)and uPA(P＜0.001)were selected as the most significant prognostic factors in a multivariate analysis by Cox proportional hazard regression model.CONCLUSIONS There may be a synergistic function in the the process of growth and invasion in pancreatic cancer between Survivin and uPA.Combined analysis of Survivin and uPA may lead to a more reliable prognostic estimation,as the beneficial supplement of lymph node metastasis to judge the prognosis of pancreatic cancer.