CD68和Ki-67蛋白在腹膜后恶性纤维组织细胞瘤中的表达及意义  

The expression and clinical significance of CD68 and ki-67 in retroperitoneal malignant fibroushistiocytoma

作　　者：马超[1] 李沛雨[1] 周思欣[1] 孙成博 黄晓东[1] 张颖[1] 赵旭东[1] Ma Chao, Li Peiyu, Zhou Sixin, Sun Chengbo, Huang Xiaodong, Zhang Ying, Zhao Xudong(Department of General Surgery, Chinese People＇ s Liberation Army General Hospital, Beijing 100853, Chin)

机构地区：[1]解放军总医院普通外科,北京100853

出　　处：《中国医师进修杂志》2017年第10期873-878,共6页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 探讨肿瘤相关巨噬细胞（TAMs）标志物CD68和核增殖标志物Ki-67在腹膜后恶性纤维组织细胞瘤的表达情况及临床意义.方法 回顾性分析2000年2月至2015年12月收治的35例腹膜后恶性纤维组织细胞瘤患者的完整临床资料及随访资料.其中男24例,女11例,年龄18~71（53.0±10.8）岁,根据CD68表达情况分为CD68阳性组（21例）和CD68阴性组（14例）;根据Ki-67表达情况分为Ki-67低表达组（〈20%）与Ki-67高表达组（≥20%）,比较两组的临床病理特点及预后差异.单因素生存分析采用Kaplan-Meier法计算,Log-rank检验,多因素生存分析采用Cox风险比例模型.两个指标的表达差异采用Fisher确切概率法;采用Spearman进行等级资料相关性分析.结果 本组患者中,18例接受了根治性手术切除,17例行部分切除.中位生存时间17（1~86）个月.患者总体1、3、5年生存率分别为65.7%、22.9%、8.6%.Log-rank检验显示法国联邦癌症中心（FNCLCC）分级（x2=7.002,P=0.008）、手术切除程度（x2=7.134,P=0.008）、CD68表达（x2=4.634,P=0.031）、Ki-67表达（x2=8.898,P=0.003）是患者术后生存时间的影响因素.而性别、年龄、肿瘤最大直径、失血量、有无脏器联合切除和术后有无辅助治疗对患者的术后生存时间无影响（P值均〉0.05）.多因素分析显示：手术切除程度（RR=3.755,P=0.003）和Ki-67表达（RR=4.471,P=0.002）是预后的独立影响因素.同时Fisher确切概率法统计分析发现CD68阳性组和CD68阴性组FNCLCC分级比较差异有统计学意义（P=0.001）.Ki-67高表达组和Ki-67低表达组在FNCLCC分级（P=0.027）、肿瘤最大直径（P=0.044）和辅助治疗（P=0.019）方面比较差异有统计学意义.结论 腹膜后恶性纤维组织细胞瘤预后较差,手术根治切除是目前主要治疗方法.TAMs标志物CD68阳性、核增殖标志物Ki-67高表达（≥20%）的患者术后生存期短,二者在腹膜后恶性纤维组织细胞瘤的�Objective To identify the expression of CD68-tumor-associated macrophages （TAMs） and proliferative marker Ki-67 in retroperitoneal malignant fibrous histiocytoma （MFH） and their clinical significance. Methods Clinical data about 35 patients with retroperitoneal MFH managed with surgery from February 2002 to December 2015 were retrospectively analyzed and all patients were followed up. There were 24 male and 11 female patients, and they were 18-71 years old, with mean age （53.0 ± 10.8） years old. Patients were divided into CD68 positive group （21 patients） and CD68 negative group （14 patients）, while they were also divided into Ki-67 low expression （〈 20%） group and Ki-67 high expression （ ≥ 20%） group, according to the immunohistochemical staining results. The overall survival time and all clinical data between two groups were compared. Kaplan-Meier estimations, Cox regression analysis, Fisher exact probabilities and Spearman correlations were performed. Results Of the 35 patients, 18 patients received radical resection, and 17 patients received palliative operation. The overall 1-, 3-, 5-year survival rates were 65.7%, 22.9%and 8.6%and the median survival was 17 （1-86） months. Factors associated with postoperative survival were FNCLCC grade （x2=7.002, P=0.008）, modusoperandi of the tumor resection（x2=7.134, P=0.008）, and CD68（x2=4.634, P=0.031） and Ki-67 overexpression （≥20%） （x2=8.898, P=0.003 ） . The difference between gender, age, tumor size, blood loss, removal of the joint organs and adjuvant therapy got no statistical significances （P 〉 0.05）. Multivariate analysis showed that survival was associated with modusoperandi of the tumor resection and Ki-67 overexpression （P=0.003, 0.002, respectively）. Conclusions Retroperitoneal malignant fibrous histiocytoma is a rare malignancy that display poor prognosis and high mortality. Complete resection remains the mainstream for retroperitoneal malignant fibrous histiocytoma. The patients＇ life sp

关 键 词：恶性纤维组织细胞瘤 腹膜后肿瘤 预后 CD68 KI-67 

分 类 号：R735.4[医药卫生—肿瘤]