拓扑异构酶Ⅱα在结直肠癌组织中的表达及其临床意义  

Expression and significance of topoisomerase Ⅱα in colorectal caner

作　　者：高显华[1] 于志奇[1] 张畅[1] 傅传刚[1] 徐晓东[1] 邢俊杰[1] 

机构地区：[1]第二军医大学附属长海医院肛肠外科,上海200433

出　　处：《国际外科学杂志》2012年第8期522-525,F0003,共5页International Journal of Surgery

基　　金：国家自然科学基金面上项目（No.30973460）,上海市科委科技攻关项目（No.07dz19505）

摘　　要：目的探讨拓扑异构酶Ⅱα在结直肠癌组织中的表达水平及其与各临床病理因素、长期预后之间的关系。方法采用EnVision免疫组化法检测490例结直肠癌患者组织中拓扑异构酶Ⅱα蛋白的表达水平，分析它与各临床病理因素之间的关系，并采用Kaplan—Meier分析和多因素COX回归分析研究其在预后预测中的价值。结果拓扑异构酶Ⅱα的表达水平与T分期（P=0．042）、N分期（P=0．038）呈负相关；与局部复发率（P=0．053）也呈负相关，差异均有统计学意义。Kaplan—Meier分析显示拓扑异构酶Ⅱα的表达水平与患者的总生存时间（P=0．022）和无瘤生存时间（P=0．036）呈正相关。多因素COX回归分析显示拓扑异构酶Ⅱα的表达水平（P=0．017）、血清CEA（P〈0．001）、CA199（P=0．002）、肿瘤的分化程度（P=0．001）和Dukes分期（P〈0．001）是结直肠癌患者总生存时间的独立影响因素。结论拓扑异构酶Ⅱα的表达水平是结直肠癌的独立预后因素，联合检测拓扑异构酶Ⅱα、CEA、CA199和肿瘤的分化程度有助于结直肠癌患者的预后判断和为患者选择个性化的治疗方案，尤其是那些早期的结直肠癌和结肠镜下切除的已癌变的息肉。Objective To determine the relationship between expression of topoisomerase Ⅱα and elinieopathological factors, overall survival in colorectal caner. Methods Expression of topoisomerase Ⅱα was measured using EnVision immunohistochemistry in 490 colorectal cancer patients. The relationship between topoisomerase Ⅱα expression and various clinicopathological parameters was analyzed. Kaplan-Meier analyses and multivariate analyses were used to evaluate the significance of topoisomerase Ⅱα expression in prognosis prediction. Results Overexpression of topoisomerase Ⅱα was found to be related with lower T stage （ P = 0. 042 ）, lower N stage （ P = 0. 038 ） , and possibly with lower recurrence rate （ P = 0. 053 ）. KaplanMeier analyses showed that overexpression of topoisomerase Ⅱα was related with prolonged overall survival （P = 0. 022） and prolonged disease-free survival （P = 0. 036）. Multivariate analyses showed that elevated serum CEA （P 〈 0. 001 ） , elevated serum CA199 （P = 0. 002 ）, poor differentiation （ P = 0. 001 ）, advanced Dukes stage （ P 〈 0. 001 ） and lower expression of topoisomerase Ⅱα （ P = 0. 017 ） were independent predictive factors for poor prognosis. Conclusions Expression of topoi- somerase Ⅱα is a favorable predictive factor for colorectal cancer, and would be useful in prognosis prediction and treatment selection for early colorectal cancer and malignant colorectal polyps, especially when it is used in combinations with serum CEA, CA199 and differentiation.

关 键 词：DNA拓扑异构酶类 Ⅱ型 结肠肿瘤 直肠肿瘤 预后 

分 类 号：R735.3[医药卫生—肿瘤]