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目的 寻找影响大肠癌患者根治术后生存的预后因素。方法 选取根治术大肠癌原发病例120例,查阅病历及5年以上随访资料。并取病例的存档石蜡块,切片后进行 SP免疫组化方法检测p53、C-erbB 2、nm23-H1、Ras四个基因蛋白表达物。结果 p53、C erbB 2、Ras、nm23 H1 蛋白在120例大肠癌组织中阳性表达率分别为62.5%(75/120)、25.8%(31/120)、80.0%(96/120)、60.8%(73/120)。将分子生物学标志物与临床病理指标相结合,经Cox单因素分析,在α=0.05水平,结果显示:肿瘤大体分型、组织学分级、浸润深度、淋巴结转移、Dukes’分期、p53、Ras、nm23 H1 为有意义的预后影响因素(P<0.05)。Cox多因素分析结果显示,在α=0.05水平,Dukes’分期、p53、nm23 H1 是影响大肠癌患者预后的独立指标(P=0.000),其 RR 值分别为3.06、6.02、0.40。由此建立的预后预测模型为:h( t, x)=h0( t )exp(- 0. 9269X14+ 1. 1197X10+ 1. 7948X11),其预测预后的灵敏度为79.1%,特异度为83.0%,符合率为80.8%,Kappa值为0.62。结论 Dukes’分期、p53、nm23 H1 是影响大肠癌患者根治术后生存重要的预后指标,由此建立的预后预测模型具有较高的信度和效度,可为临床医师对大肠癌患者个体预后结局估计提供有力的工具。
Objective To find the prognostic factors that affect the survival of patients with colorectal cancer after radical surgery. Methods A total of 120 cases of primary colorectal cancer undergoing radical operation were selected. The medical record and the follow-up data of more than 5 years were reviewed. Paraffin blocks were taken from the patients and sliced for immunohistochemistry to detect the expression of p53, C-erbB 2, nm23-H1 and Ras. Results The positive rates of p53, C erbB 2, Ras and nm23 H1 protein in 120 cases of colorectal cancer were 62.5% (75/120), 25.8% (31/120), 80.0% (96/120), 60.8% (73/120). According to Cox univariate analysis, the molecular biomarkers were combined with clinicopathological parameters. The results showed that there was no significant difference in tumor size, histological grade, depth of invasion, lymph node metastasis, Dukes’ stage, p53, Ras , Nm23 H1 is a significant prognostic factor (P <0.05). Cox multivariate analysis showed that Dukes’ stage, p53 and nm23 H1 were independent prognostic indicators in patients with colorectal cancer (P = 0.000) at α = 0.05, with RRs of 3.06, 6.02 and 0.40 respectively. The predicted prognosis model was as follows: h (t, x) = h0 (t) exp (-0.9269X14 + 1.1197X10 + 1.7948X11). The sensitivity and specificity of prognosis were 79.1% and 83.0% The rate was 80.8% with a Kappa value of 0.62. Conclusions Dukes’ stage, p53 and nm23 H1 are important prognostic indicators of survival after radical operation in patients with colorectal cancer. The prognosis prediction model established by this method has high reliability and validity and can be used to evaluate the prognosis of patients with colorectal cancer Outcome estimates provide a powerful tool.