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目的:探讨喉癌手术切缘组织中p53、p21、PCNA及COX-2蛋白的表达与肿瘤局部复发的关系。方法:选取2005-11-2010-12期间住院的98例喉癌患者,病理检查均为早期喉鳞状细胞癌,所有患者均实施CO2激光手术方式切除,切除整块肿瘤后,留取肿瘤原发灶组织和手术切缘组织,保留5mm癌周组织作为手术切缘标本。采用SP法进行免疫组织化学检测,每3~6个月门诊或电话随访,对局部组织复发情况进行详细记录,随访3.0~4.5年。结果:198例喉癌患者的肿瘤组织中p53、p21、PCNA及COX-2蛋白的阳性率为65.3%、52.0%、70.4%及69.4%;手术切缘组织中p53、p21、PCNA及COX-2蛋白的阳性率为23.5%、39.8%、32.7%及30.6%;差异有统计学意义(均P<0.05);p53、p21、PCNA及COX-2蛋白在喉癌组织中的表达与肿瘤的分级及TNM分期无关。298例患者随访3年以上,局部复发17例(17.3%)。切缘组织中p53、p21、PCNA及COX-2阳性表达的患者复发率高于阴性表达的患者(P<0.05),其中p53和p21、PCNA和COX-2检测共阳性的患者复发率显著高于单阳性的患者(P<0.05)。3p21在p53阳性切缘组织中的阳性表达显著高于其在阴性切缘组织中的表达;PCNA在p21、COX-2阳性切缘组织中的阳性表达显著高于其在阴性切缘组织中的表达(P<0.01);但PCNA在p53阳性切缘组织中的阳性表达与其在阴性切缘组织中的表达差异无统计学意义(P>0.05)。结论:通过探讨p53、p21、PCNA及COX-2在喉癌细胞增生及局部复发过程中的作用,提示生化代谢与分子结构水平表达异常先于细胞形态表观的改变,建议对阳性指标进行随访检测,阳性表达的患者可采取相应的措施对症干预。
Objective: To investigate the relationship between the expression of p53, p21, PCNA and COX-2 in the marginal tissue of laryngeal carcinoma and the local recurrence of the tumor. Methods: A total of 98 cases of laryngeal cancer hospitalized during 2005-11-2010-12 were selected. The pathological examination was all laryngeal squamous cell carcinoma. All cases underwent CO2 laser surgery. After removal of the entire tumor, Focal tissue and surgical margins, 5mm marginal tissue retained as surgical margin specimens. SP immunohistochemical detection, every 3 to 6 months out-patient or telephone follow-up, the local tissue recurrence were recorded in detail, followed up 3.0-4.5 years. Results: The positive rates of p53, p21, PCNA and COX-2 in 198 cases of laryngeal cancer were 65.3%, 52.0%, 70.4% and 69.4%, respectively. The positive rates of p53, The positive rates of p53, p21, PCNA and COX-2 in laryngeal squamous cell carcinoma were 23.5%, 39.8%, 32.7% and 30.6%, respectively (all P <0.05) Grading and TNM stage has nothing to do. 298 patients were followed up for more than 3 years, 17 cases (17.3%) were locally recurred. The recurrence rate of the positive expression of p53, p21, PCNA and COX-2 in the marginal tissue was higher than that in the negative expression (P <0.05). The recurrence rates of p53, p21, PCNA and COX- In single-positive patients (P <0.05). The positive expression of 3p21 in p53 positive margin was significantly higher than that in negative margin. The positive expression of PCNA in p21 and COX-2 positive margin was significantly higher than that in negative margin (P <0.01). However, there was no significant difference in the expression of PCNA between p53 positive margins and negative margins (P> 0.05). Conclusion: To explore the role of p53, p21, PCNA and COX-2 in the proliferation and local recurrence of laryngeal squamous cell carcinoma, which suggests that abnormal expression of biochemical metabolism and molecular structure precedes the change of cell morphology. It is suggested that the positive indicators should be followed up Detection, positive expression of patients can take appropriate measures symptomatic intervention.