MUC5B与PDCD4蛋白在肝内胆管细胞癌中表达的临床意义  

Clinical significance of expression of MUC5B and PDCD4 protein in intrahepatic cholangiocellular carcinoma

作　　者：李金海 蔡福景 翟华伟 杨雨[3] 孙广正 张海峰 朱明辉 林跃 潘升华 李淑群[5] Li Jinhai;Cai Fujing;Zhai Huawei;Yang Yu;Sun Guangzheng;Zhang Haifeng;Zhu Minghui;Lin Yue;Pan Shenghua;Li Shuqun(Department of Hepatobiliary Surgery,the Third Affiliated Hospital of Wenzhou Medical University,Wenzhou 325200,China;Department of Infection,the Third Affiliated Hospital of Wenzhou Medical University,Wenzhou 325200,China;Department of Hepatobiliary and Pancreatic Surgery,the Third Affiliated Hospital of Soochow University,Changzhou 213000,China;Department of Pathology,the Third Affiliated Hospital of Wenzhou Medical University,Wenzhou 325200,China;Department of Hepatobiliary Pancreatic Surgery,Affiliated Hospital of Guilin Medical University,Guilin 541000,China)

机构地区：[1]温州医科大学附属第三医院肝胆外科,温州325200 [2]温州医科大学附属第三医院感染科,温州325200 [3]苏州大学附属第三医院肝胆胰外科,常州213000 [4]温州医科大学附属第三医院病理科,温州325200 [5]桂林医学院附属医院肝胆胰外科,桂林541000

出　　处：《中华肝胆外科杂志》2024年第10期755-760,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：温州市科技局计划(Y2023490);浙江省医药卫生科技计划(2022KY353)。

摘　　要：目的分析探讨肝内胆管细胞癌(ICC)患者黏蛋白5B(MUC5B)和程序性细胞死亡因子4(PDCD4)蛋白的表达特点,构建预测预后的列线图模型。方法回顾性选取2009年9月至2020年9月在温州医科大学附属第三医院行根治性手术切除且经术后病理确诊为ICC的100例患者的临床资料,其中男性46例,女性54例,年龄(56.9±12.2)岁。采用免疫组化法检测100例ICC组织和相应癌旁组织中MUC5B和PDCD4蛋白的表达情况,并分析其与ICC患者临床病理因素之间的关系。单因素及多因素Cox回归分析对ICC患者术后预后的影响因素,使用rms程序包构建列线图模型,并进行内部验证。结果ICC组织中MUC5B蛋白阳性表达率为76.0%(76/100),高于癌旁组织的27.0%(27/100),差异有统计学意义(χ^(2)=11.33,P=0.015);ICC组织中PDCD4蛋白阳性表达率为21.0%(21/100),低于癌旁组织的73.0%(73/100),差异有统计学意义(χ^(2)=15.57,P=0.007)。多因素Cox回归分析表明,肿瘤糖类抗原19-9>37 kU/L、肿瘤长径>5 cm、肿瘤TNM分期Ⅱ/Ⅲ期、肿瘤中/低分化、MUC5B阳性表达、PDCD4阴性表达的ICC患者,切除术后生存时间短的风险高(均P<0.05)。基于上述指标构建列线图模型,C指数为0.801,术后生存校准曲线图显示该列线图模型预测生存贴合度高,受试者工作特征曲线下面积为0.862。结论ICC组织中MUC5B蛋白阳性表达与PDCD4蛋白阴性表达提示ICC患者的预后不良,基于MUC5B及PDCD4蛋白表达构建的列线图模型区分度好、预测效能理想。ObjectiveTo investigate the expression characteristics of mucin 5B(MUC5B)protein and programmed cell death factor 4(PDCD4)protein in patients with intrahepatic cholangiocarcinoma(ICC),and to construct a nomogram model for prognosis prediction.MethodsClinical data of 100 patients who underwent radical surgical resection and were diagnosed as ICC by postoperative pathology from September 2009 to September 2020 in the Third Affiliated Hospital of Wenzhou Medical University were retrospectively selected,including 46 males and 54 females,aged(56.9±12.2)years old.Immunohistochemistry was used to detect the expression of MUC5B and PDCD4 protein in 100 cases of ICC and corresponding adjacent tissues respectively,and the relationship between them and clinicopathological factors of ICC patients was analyzed.Univariate and multivariate Cox regression analysis were performed to analyze the influencing factors on postoperative prognosis of ICC patients.The nomogram model was constructed using rms package and performed internal verification.ResultsThe positive expression rate of MUC5B protein in ICC was 76.0%(76/100),which was higher than that in para-cancer tissues 27.0%(27/100),and the difference was statistically significant(χ^(2)=11.33,P=0.015).While the positive expression rate of PDCD4 protein in ICC was 21.0%(21/100),which was lower than that in normal tissues 73.0%(73/100),and the difference was statistically significant(χ^(2)=15.57,P=0.007).Multivariate Cox regression analysis showed that ICC patients with carbohydrate antigen 19-9>37 kU/L,tumor length>5 cm,tumor TNM stageⅡ/Ⅲ,tumor medium/low differentiation,MUC5B positive expression,and PDCD4 negative expression had a high risk of short survival after resection(all P<0.05).The nomogram model was constructed based on the above indicators,and the C-index was 0.801.The postoperative survival calibration curve showed that the high predictive survival fit of the nomogram model,and the area under the receiver operating characteristic curve was 0.862.ConclusionsPosit

关 键 词：列线图 肝内胆管细胞癌 黏蛋白5B 程序性细胞死亡因子4 免疫组化 

分 类 号：R735.7[医药卫生—肿瘤]