Ewing肉瘤p53表达与患者病理和预后分析  

Expression of p53 in Ewing Sarcoma and Its Relationship with Clinicopathologic Characteristics and Overall Survival

作　　者：杨飏 吴敬国[2] YANG Yang;WU Jing-guo(Department of Pathology,The First Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510080,China;Department of General Internal Medicine,The First Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院病理科,广东广州510080 [2]中山大学附属第一医院普内科,广东广州510080

出　　处：《中山大学学报（医学版）》2018年第6期897-903,共7页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金青年科学基金项目(81402413);国家自然科学基金面上项目(81772862);中山大学青年教师培育项目(16ykpy42)

摘　　要：【目的】探讨Ewing肉瘤中p53表达与患者临床病理特征的关系及预后价值。【方法】我们回顾性分析了108例Ewing肉瘤患者。使用免疫组化法检测Ewing肉瘤组织中p53的表达,并用卡方检验、Kaplan-Meier生存曲线、Log-rank检验及Cox比例风险回归模型评估p53表达与Ewing肉瘤患者临床病理特征及总体生存的相关性。【结果】Ewing肉瘤中p53表达阳性率为15.7%(17/108)。p53阳性表达与某些进展期临床病理参数呈正相关,包括患者首诊时已发生转移(P=0.007)以及血管/神经侵袭(P=0.023),Log-rank检验显示p53阳性组和阴性组总体生存曲线的差异具有统计学意义(P <0.001),单因素方差分析显示p53阳性表达者死亡风险高于p53阴性表达者,差异具有统计学意义(P <0.001)。此外,我们创建了一个新的分子分期体系,将p53表达水平与首诊时的临床分期相结合对患者进行预后分类,进一步提高了传统临床分期的预后能力。多因素Cox回归分析结果显示,p53和首诊时的临床分期是两个最强的独立预后因子(皆P <0.001)。【结论】p53表达可作为Ewing肉瘤的一个独立的不良预后因子;新预后评估体系综合了p53表达水平与Ewing肉瘤临床分期,可显著优化Ewing肉瘤患者的预后分层。【Objective】To investigate the clinicopathological relevance and prognostic value of p53 expression in Ewing sarcoma.【Methods】A total of 108 cases of Ewing sarcoma patients were retrospectively analyzed.p53 expression were detected by immunohistochemistry and the prognostic effect of p53 expression on clinicopathologic parameters and overall survival were analyzed by chi-square test,Kaplan-Meier curves,log-rank test and Cox regression model.【Results】p53 was positively expressed in 17(15.7%)patients.Positive expression of p53 correlated significantly with some advanced clinicopathologic parameters including metastatic stage at initial diagnosis(P=0.007)and venous/nerve invasion(P=0.023).Moreover,positive expression of p53 was significantly related to poor overall survival of patients with Ewing sarcoma by log-rank test(P<0.001)and univariate analysis(P<0.001).Then,we constructed a novel molecular staging system which combined p53 expression and clinical stage classification at diagnosis and further refined the prognostic ability of conventional clinical staging.Finally,a multivariate Cox regression analysis indicated that p53 and initial stage were the most significant independent predictors of survival(P<0.001 and P<0.001,respectively).【Conclusions】p53 expression was an independent adverse prognostic factor for overall survival in patients with Ewing sarcoma.Integrating p53 into clinical staging significantly enhanced prognostic stratification.

关 键 词：P53 EWING肉瘤 临床病理特征 预后指标 

分 类 号：R73-31[医药卫生—肿瘤]