Ki-67和DNA拓扑异构酶Ⅱα表达对原发性肝癌患者肝移植手术预后的价值  

Ki-67 and DNA topoisomerase Ⅱα predict survival in patients with primary hepatocellular carcinoma after liver transplantation

作　　者：杨杰[1] 曹毅[1] 柯瑞盛 潘凡[2] 吕立志[2] 

机构地区：[1]福建医科大学福总临床医学院,福州350025 [2]南京军区福州总医院肝胆外科

出　　处：《中华肝胆外科杂志》2016年第10期687-691,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：福建省自然科学基金重点项目（2014Y0034）

摘　　要：目的研究Ki-67及DNA拓扑异构酶Ⅱα（TopoⅡα）表达与肝细胞癌肝移植患者预后的关系。方法收集南京军区福州总医院2001—2012年行经典原位肝移植治疗的105例原发性肝细胞癌患者的石蜡包埋标本。应用免疫组化染色法检测肿瘤组织中Ki-67和TopoⅡα的表达，并对临床病理及术后随访资料进行统计学分析。结果Ki-67阳性率为43．8％。TopoⅡα阳性率为49．5％。Ki-67和TopoⅡα共同高表达者占33．3％，而Ki-67或TopoⅡα低表达者占66．7％。Ki-67与TopoⅡα两者的表达呈正相关（r=0．469，P〈0．01）。COX多因素分析显示患者5年无复发生存率与Ki-67高表达（HR=2．296，P〈0．05）相关，Kaplan—Meier分析显示Ki-67高表达患者与Ki-67低表达患者术后5年无复发生存率差异有统计学意义（40．4％比57．6％，P〈0．05）。COX多因素分析显示患者5年总生存率与肿瘤大小（HR=1．743，P〈0．05）、AFP水平（HR=2．291，P〈0．05）、肿瘤分化（HR=0．283，P〈0．01）以及Ki-67（HR=1．977，P〈0．05）和TopoⅡα（HR=1．883，P〈0．05）高表达相关。Kaplan—Meier分析显示Ki-67高表达／TopoⅡα高表达患者与Ki-67低表达／TopoⅡα低表达患者术后5年总生存率差异有统计学意义（12．7％比61．1％，P〈0．01）／（13．5％比63．8％，P〈0．01）。TopoⅡα和Ki-67共同高表达患者比TopoⅡα或Ki-67低表达患者的术后5年总生存率显著降低（10．7％比54．5％，P〈0．01）。结论Ki-67高表达与肝癌肝移植患者术后复发转移相关，Ki-67和TopoIId高表达与肝癌肝移植患者的总生存率相关，Ki-67及Topo1I饯可作为肝细胞癌肝移植患者预后的预测指标。Objective To investigate whether Ki-67 and DNA topoisomerase Ⅱα （Topo Ⅱα） are effective prognostic markers in patients with primary hepatocellular carcinoma （ HCC ） after liver transplanta- tion. Methods This retrospective cohort study included 105 patients with HCC who underwent liver trans- plantation in a single center from 2001 to 2012. The demographic features, clinicopathological data, expres- sions of Topo Ⅱα and Ki-67 as detected by immunohistochemistry. The long-term survival and the potential prognostic factors, together with standard histologic parameters, were analyzed by univariate and multivariate analyses. Results A positive correlation was found between Topo Ⅱα and Ki-67 levels in HCC （ r = 0. 469, P 〈 0.01 ）. Multivariate analyses showed that Ki-67 was an independent prognostic risk factor of recurrence- free survival （HR = 2. 296, P 〈 0.05 ）. The 5-year overall survival rate was related to tumor size （ HR = 1. 743, P 〈 0.05）, AFP （HR = 2. 291, P 〈 0.05 ）, histological grade （HR = 0. 283, P 〈 0.01 ）, and high expressions of Ki-67 （ HR = 1. 977, P 〈 0.05 ） and Topo Ⅱα levels （ HR = 1. 883, P 〈 0. 05 ）. The Kaplan- Meier analysis showed that there was a significant difference in the 5-year recurrence-free survival rate （40.4% vs. 57.6% ） between patients with high and low expressions of Ki-67, which were significantly lower in the high Topo Ⅱα expression patients （ 13.5% vs. 63.8% ） （ P 〈 0.01 ）. The 5-year overall survi- val rates were significantly lower in the high Ki-67 expression patients （12. 7% vs. 61.1% , P 〈0. 01 ） when compared with the low Ki-67 expression patients, which were significantly lower in the high Topo Ⅱα and Ki-67 expression patients （ 10.7% vs. 54.5% , P 〈 0.01 ） than the low Topo Ⅱα-or Ki-67 patients. Conclusions Ki-67 was associated with recurrence and metastasis in patients with primary hepatic carcinoma after liver transplantation. High expression of both Ki-67 and Topo �

关 键 词：肝细胞癌 肝移植术 核抗原 Ki-67 拓扑异构酶Ⅱ 预后 

分 类 号：R735.7[医药卫生—肿瘤]