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目的:探讨Ki-67、p16、CK34βE12蛋白、患者病理特征及术后辅助治疗方式对可手术的宫颈癌患者的预后价值。方法:采用免疫组化法检测72例宫颈癌术后病理组织中Ki-67、p16、CK34βE12蛋白的表达,结合患者病理特征及治疗方式,以患者疾病进展为研究终点,随访截止至2016年10月。单因素分析采用Kaplan-Meier法,多因素分析采用Cox回归分析。结果:单因素分析显示:Ki-67(P=0.006)、CK34βE12(P=0.007)、生产次数(P=0.018)、绝经情况(P=0.008)、民族(P=0.034)、有无疼痛(P=0.008)、肿瘤分期(P=0.000)、肿瘤大小(P=0.015)、淋巴结转移情况(P=0.000)、化疗情况(P=0.016)与患者预后相关。Cox分析结果显示:宫颈癌患者的Ki-67表达情况、发病年龄、怀孕次数、生产情况、绝经情况、肿瘤分期、是否深肌层受到侵犯、是否沿子宫侵犯、是否放疗是影响可手术宫颈癌患者PFS的显著性因素(P<0.05)。而患者p16和CK34βE12蛋白的表达、肿瘤大小、分化程度、初潮年龄、民族、职业、手术和化疗情况等对PFS无明显影响(P>0.05),尚不能作为独立的预后因素。结论:Ki-67的高表达、低龄、早产、肿瘤分期晚、深肌层及沿子宫受侵犯、放射治疗均为宫颈癌的独立预后因素;p16和CK34βE12蛋白的表达、肿瘤大小、分化程度、初潮年龄、民族、职业、手术和化疗情况仅与预后相关,尚不能作为独立的预后因素。
Objective: To investigate the prognostic value of Ki-67, p16, CK34βE12 protein, pathological features and postoperative adjuvant therapy in patients with operable cervical cancer. Methods: The expressions of Ki-67, p16 and CK34βE12 in pathological tissues of 72 cases of cervical cancer were detected by immunohistochemistry. The pathological changes and treatment of patients were analyzed based on the pathological features of the patients and the treatment methods. The patients were followed up until the end of 2016 month. Kaplan-Meier method was used for univariate analysis and Cox regression was used for multivariate analysis. Results: The results of univariate analysis showed that Ki-67 (P = 0.006), CK34βE12 (P = 0.007), production times (P = 0.018), menopausal cases (P = 0.008) (P = 0.008), tumor stage (P = 0.000), tumor size (P = 0.015), lymph node metastasis (P = 0.000) and chemotherapy (P = 0.016) The results of Cox analysis showed that Ki-67 expression, age of onset, number of pregnancies, production, menopause, tumor stage, whether deep myometrium was infested, whether invasion along the uterus, and whether radiotherapy affected operable cervical cancer PFS of patients with significant factors (P <0.05). P16 and CK34βE12 protein expression, tumor size, differentiation, age of menarche, ethnic, occupational, surgical and chemotherapy conditions had no significant effect on PFS (P> 0.05), but not as an independent prognostic factor. Conclusion: The high expression of Ki-67, low age, premature delivery, late tumor staging, invasion of deep myometrium and uterus were the independent prognostic factors of cervical cancer. The expressions of p16 and CK34βE12, tumor size, differentiation degree, Menarche age, ethnicity, occupation, surgery and chemotherapy are only associated with the prognosis, yet not as an independent prognostic factor.