肿瘤浸润肥大细胞对结直肠癌患者生存预测的价值  

Prognostic significance of tumor-infiltrating mast cells in colorectal cancer patients

作　　者：兰楠[1] 吴现瑞[2] 何晓生[2] 陈钰锋[2] 马晋平[4] 曾杨[2] 袁瑞学[3] 吴小剑[2] 

机构地区：[1]中山大学中山医学院,广州510080 [2]中山大学附属第六医院结直肠肛门外科,广州510655 [3]中山大学胃肠病学研究所,广州510655 [4]中山大学附属第一医院胃肠胰腺外科,广州510080

出　　处：《中华消化外科杂志》2012年第3期284-289,共6页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（81072046）;教育部博士点专项基金（20100171110075）;中山大学青年教师培育项目（10ykpy01）

摘　　要：目的探讨肿瘤浸润肥大细胞（TIM）在结直肠癌患者中的预后价值。方法收集2002年1月至2005年12月中山大学附属第一医院收治的282例行首次根治性切除的结直肠癌患者的肿瘤石蜡标本，通过免疫组织化学染色计算TIM的密度，根据TIM的平均密度[（8．4±6．5）／高倍视野]，将患者分为TIM少量浸润组（TIM平均密度〈8．4／高倍视野）和TIM大量浸润组（TIM平均密度≥8．4／高倍视野），比较两组患者的临床病理因素及其预后情况。计量资料采用t检验，计数资料采用X2检验。采用Kaplan—Meier法绘制生存曲线，Log—rank检验分析患者生存情况。影响结直肠癌患者生存时间的单因素及多因素分析采用COX比例风险模型。结果TIM在结直肠癌患者中均有不同程度的浸润。TIM少量浸润组和TIM大量浸润组患者在结直肠癌的N分期和TNM分期方面比较，差异有统计学意义（X2=6．025，7．410，P〈0．05）。随访截至2010年9月，TIM少量浸润组、TIM大量浸润组患者的5年总生存率和无瘤生存率分别为82．9％、79．0％和63．1％、59．3％，两组比较，差异均有统计学意义（P〈0．05）。COX比例风险模型单因素分析结果显示，肥大细胞在肿瘤组织中的浸润是影响结直肠癌患者总生存时间和无瘤生存时间的不良因素（RR=2．119，95％可信区间1．326～3．386；RR=2．084，95％可信区间1．357～3．199，P〈0．05）。多因素分析结果显示TIM是结直肠癌患者总生存时间和无瘤生存时间的独立影响因素（RR=1．651，95％可信区间1．009～2．702；RR=1．680，95％可信区间1．047～2．629，P〈0．05）。结论TIM与结直肠癌的N分期和TNM分期相关，并且TIM是结直肠癌患者预后不良的独立影响因素。Objective To investigate the relationship between tumor-infiltrating mast cell （TIM） and the clinicopathological and prognostic factors of patients with colorectal cancer. Methods A total of 282 cases of paraffin-embedded colorectal cancer specimens were obtained from the First Affiliated Hospital of Sun Yat-sen University from January 2002 to December 2005. The density of TIM was determined by immunohistochemical staining. According to the mean TIM density detected [ （ 8.4 _＋ 6.5 ）/HPF 1, all the patients were divided into low-TIM density group （mean TIM density 〈 8.4/HPF） and high-TIM density group （mean TIM density I〉 8.4/ HPF）. The clinicopathological factors and the prognosis of patients between high-TIM density group and low-TIM density group were compared. All data were analyzed using the t test or chi-square test. The survival curve was drawn using the Kaplan-Meier method, and the survival of the patients was analyzed by the Log-rank test. The clinicopathological factors were analyzed retrospectively with the univariate and multivariate COX regression model. Results TIM was detected in all the patients with colorectal cancer. Significant differences were observed in the nmnber of patients in N stage and TNM stage between patients in the high-TIM density group and those in the low- TIM density group （ X2 = 6. 025,7. 410, P 〈 0.05 ）. All patients were followed up till September 2010, the 5-year overall and tumor-free survival rates of patients were 82.9% and 63.1% in the low-TIM density group, 79.0% and 59.3% in the high-TIM density group, with significant difference between the 2 groups （ P 〈 0.05 ）. COX proportional hazard regression model revealed that high density of TIM was associated with short overall survival time and tumor-free survival time of colorectal cancer patients （RR = 2. 119, 95 % CI 1. 326-3. 386; RR = 2. 084, 95 % CI 1. 357-3. 199, P 〈0.05 ）. The results of multivariate analysis showed that high density of TIM was the independent factor influencing

关 键 词：结直肠肿瘤 肿瘤浸润肥大细胞 预后 

分 类 号：R735.3[医药卫生—肿瘤]