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目的探讨消化道肿瘤淋巴结转移灶多药耐药性(MDR)的变化。方法对55例胃癌、大肠癌原发灶及相应淋巴结转移灶分别进行MDR相关蛋白(MRP)、P-糖蛋白(gp)、DNA拓扑异物酶(Topo)Ⅱα、谷胱甘肽S转移酶(GST)-л免疫组织化学染色,比较二病灶间诸指标表达程度的差异。结果原发灶与淋巴结转移灶比较:(1)两者的MRP、P-gp、TopoⅡα、GST-л表达一致率分别为32．7％、40．0％、45．5％、50．9％;(2)P-gp、GST-л阳性表达差异均有统计学意义(P<0．01); (3)中高分化腺癌的MRP、TopoⅡα阳性表达差异均有统计学意义(P<0．01,P<0．05),低分化腺癌仅GST-л阳性表达差异有统计学意义(P<0．01)。中高分化腺癌与低分化腺癌比较:原发灶中TopoⅡα阳性表达、转移灶中MRP及TopoⅡα阳性表达差异均有统计学意义(P<0．05)。结论消化道肿瘤淋巴结转移灶存在MDR的异质性变化,肿瘤原发灶的耐药基因相关蛋白表达水平不能预测淋巴结转移灶的MDR。
Objective To investigate the changes of multidrug resistance (MDR) in lymph node metastases of digestive tract tumors. METHODS: MDR-related protein (MRP), P-glycoprotein (gp), DNA topoisomerase (Topo) IIα, and glutathione S-transferase were performed in 55 cases of gastric cancer, primary colorectal cancer and corresponding lymph node metastasis. GST)-л immunohistochemical staining, comparing the differences in the expression of the two indicators between the two lesions. RESULTS Primary lesions compared with lymph node metastases: (1) The agreement rates of MRP, P-gp, TopoIIα, and GST-л were 32.7%, 40.0%, 45.5%, and 50.9 respectively. (2) There was significant difference in the positive expression of P-gp and GST-л (P<0.01). (3) The positive expression of MRP and TopoIIα in moderately well-differentiated adenocarcinoma were statistically significant (P< 0.01, P<0.05). The difference of GST-positive expression in poorly differentiated adenocarcinoma was statistically significant (P<0.01). The comparison of moderately differentiated adenocarcinoma with poorly differentiated adenocarcinoma: positive expression of TopoIIα in the primary tumor, positive expression of MRP and TopoIIα in metastasis were statistically significant (P<0.05). Conclusion The heterogeneity of MDR exists in the lymph node metastasis of digestive tract tumors. The expression level of drug-resistant gene-related proteins in the tumor primary tumor can not predict the MDR of lymph node metastases.