上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

宫颈鳞癌转移淋巴结乙酰肝素酶的表达及临床意义

卢书芳，胡 滨，李元昆，周新欢，崔金全   

  1. 郑州大学第二附属医院妇产科， 郑州 450014
  • 出版日期:2013-09-28 发布日期:2013-09-29
  • 通讯作者: 崔金全, 电子信箱: jinquan_cui@163.com。
  • 作者简介:卢书芳（1988—），女，硕士生; 电子信箱: lushufang9@163.com。
  • 基金资助:

    河南省教育厅科学技术研究重点项目（12A320024）

Expression and clinical significance of heparanase in metastatic lymph nodes of cervical squamous carcinoma

LU Shu-fang, HU Bin, LI Yuan-kun, ZHOU Xin-huan, CUI Jin-quan   

  1. Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, China
  • Online:2013-09-28 Published:2013-09-29
  • Supported by:

    Key Grant of Henan Provincial Education Department, 12A320024

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摘要：

目的 检测转移淋巴结乙酰肝素酶（HPA）的表达水平，探讨其在宫颈鳞癌淋巴结转移诊断中的作用。方法 采用免疫组织化学S-P法检测HPA在宫颈鳞癌淋巴结转移者（A组）和淋巴结未转移者（B组）的表达情况，A组选取原发灶、转移淋巴结及未转移淋巴结3个部位，B组选取原发灶和淋巴结2个部位。结合图像分析技术检测各组中HPA表达的平均灰度值和阳性单位，CK19为鳞状上皮标记。结果 A组原发灶、转移淋巴结与未转移淋巴结HPA平均灰度值逐渐增高，HPA阳性单位逐渐降低，组内比较，差异均有统计学意义（P=0.000）；B组原发灶HPA平均灰度值明显低于淋巴结（P=0.000），原发灶HPA阳性单位明显高于淋巴结（P=0.037）。淋巴结HPA的表达率与宫颈鳞癌分期（P=0.013）、分化程度（P=0.000）、淋巴结转移（P=0.000）密切相关。所有患者的中位生存时间（MOS）为49.0个月，淋巴结转移者MOS为36.0个月，明显低于淋巴结未转移者的58.5个月（P=0.023）；淋巴结HPA阳性表达者MOS为38.5个月，淋巴结HPA阴性MOS为57.0个月，二者比较差异有统计学意义（P=0.040）。Cox模型多因素分析显示淋巴结转移、HPA表达是影响宫颈癌患者预后的独立危险因素（P<0.05）。结论 HPA可作为宫颈鳞癌淋巴结转移的生物学指标，淋巴结HPA阳性的患者预后较差。

关键词: 宫颈癌, 乙酰肝素酶, CK19, 淋巴结, 预后

Abstract:

Objective To detect the expression of heparanase (HPA) in metastatic lymph nodes, and investigate its role in the diagnosis of lymph node metastasis of cervical squamous carcinoma. Methods The expression of HPA in cervical squamous carcinoma with lymph node metastasis (group A) and cervical squamous carcinoma without lymph node metastasis (group B) was detected by immunohistochemical S-P method. Primary foci, metastatic lymph nodes and non-metastatic lymph nodes were selected for group A, and primary foci and non-metastatic lymph nodes for group B. Image analysis technique was employed to determine the average gray values and positive units of expression of HPA, and CK19 was a marker of squamous epithelia. Results In group A, the average gray values of HPA in primary foci, metastatic lymph nodes and non-metastatic lymph nodes gradually increased, and the positive units of HPA gradually decreased, with significant differences (P=0.000). In group B, the average gray value of HPA in primary foci was significantly lower than that in lymph nodes (P=0.000), and the positive unit of HPA in primary foci was significantly higher than that in lymph nodes (P=0.037). The expression rate of HPA in lymph node was significantly related to clinical stage (P=0.013), differentiation (P=0.000) and lymph node metastasis (P=0.000). The median overall survival (MOS) of all patients was 49.0 months, and MOS of patients with lymph node metastasis (36.0 months) was significantly lower than that of patients without lymph node metastasis (58.5 months) (P=0.023). MOS of patients with HPA positive lymph nodes (38.5 months) was significantly lower than that of patients HPA negative lymph nodes (57.0 months)(P=0.040). Cox regression analysis revealed that lymph node metastasis and expression HPA were independent risk factors for prognosis of cervical cancer (P<0.05). Conclusion HPA may be an important biomarker of lymph node metastasis of cervical squamous carcinoma, and patients with HPA positive lymph nodes may have poorer prognosis.

Key words: cervical cancer, heparanase, CK19, lymph node, prognosis