摘要 目的探讨影响结直肠癌同时性肝转移发生的危险因素,以期能够提高结直肠癌肝 转移的早期诊断水平。 方法回顾性分析2004年2月至2008年4月间上海交通大学附属新华医院外科经手术 治疗的579例结直肠癌患者的临床病理资料,其中77例有同时性肝转移,502例无肝 转移者作为对照,两组患者术前均未经放、化疗。结合免疫组织化学方法,利用单 因素分析、秩相关分析和多因素分析方法,研究结直肠癌同时性肝转移与临床病理 因素及结直肠癌原发灶中拓扑异构酶Ⅱ(TopoⅡ)、Ki-67、P-糖蛋白(P-gp,P170) 及谷胱甘肽S-转移酶(GST)等耐药相关蛋白表达之间的相关性。 结果单因素分析显示,腹膜侵犯、盆腔转移结节、侵及邻近组织及脏器、肿瘤长 径、肿瘤浸润肠壁周径、分化程度、浸润深度、癌栓形成、淋巴结转移与结直肠癌 同时性肝转移相关(P<)。结直肠癌原发灶中,Ki-67、P170及GST的表达与同 时性肝转移相关(P<)。多因素分析及秩相关分析显示,盆腔转移结节、侵及 邻近组织及脏器、肿瘤浸润肠壁周径、浸润深度、Ki-67和P170蛋白是结直肠癌同时 性肝转移最重要的影响因素(P<)。而且,Ki-67、P170、GST之间相互呈正相 关(P<)。 结论结直肠癌有盆腔转移结节形成、侵及邻近组织及脏器、肿瘤浸润肠壁周径1/2 圈以上、浸润至浆膜或浆膜外,Ki-67和P170阳性表达是结直肠癌同时性肝转移发生 的高危因素。Ki-67、P170与GST可作为检测结直肠癌同时性肝转移的指标。Ki-67、 P170、GST之间相互呈正相关,其上调可能是结直肠癌同时性肝转移发生发展过程中 的重要分子事件。 关键词结直肠癌;同时性肝转移;临床病理因素;耐药相关蛋白; 免疫组织化学;多因素分析 4 上海交通大学硕士学位论文 Exploration of Some Factors Related to Colorectal Cancer with Synchronous Liver Metastases
Abstract Objective To investigate the clinicopathological and immunohistochemical risk factors of colorectal cancer(CRC)with synchronous liver metastases(SLM) in order to improve the level of the early diagnosis of SLM. Methods From February 2004 to April 2008, there were 579 CRC patients underwent surgical treatment in the Department of General Surgery of XinHua Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University. The clinical data of them were analyzed retrospectively. None of them had received preoperative radiotherapy or chemotherapy. The patients were divided into two groups: one with SLM(n=77) and another without SLM(n=502). The expression of TopoⅡ, Ki-67, P170 and GST in primary CRC specimens was detected by immunohistochemistry. Then the correlation between SLM and the four resistance associated proteins and clinicopathologic factors was analyzed by means of univariate analysis, rank correlation
