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目的食管鳞癌的预后影响因素较多,本研究旨在探讨环氧合酶-2(cyclooxygenase-2,COX-2)表达与老年(≥60岁)食管鳞癌的相关性及临床意义。方法选取2008-03-01-2011-04-30在郑州大学附属肿瘤医院接受根治性放疗的43例老年食管癌患者,均行6 MV X射线根治性放疗,照射剂量60Gy。根据放疗疗效分为放射抗拒组和敏感组。采用免疫组织化学SP法对两组癌组织进行COX-2检测并对照分析。选取20例健康人组织作为对照组,比较老年食管癌患者组与对照组之间COX-2表达水平有无差异,探讨食管鳞癌组织COX-2蛋白表达与临床因素的关系。以3年总生存率为指标,对其性别、临床分期、病理类型、肿瘤部位、COX-2表达水平、化疗等与生存时间的关系进行单因素及多因素分析,探讨COX-2与预后的关系。结果放疗后3年的总生存率为23.3%(10/43)。对照组COX-2均阴性表达,老年(≥60岁)食管癌组全部阳性表达。放疗抗拒组与敏感组食管鳞癌组织中COX-2表达率分别为91.67%(11/12)和29.03%(9/31),抗拒组明显高于敏感组,差异有统计学意义,P<0.001。COX-2的表达水平与食管癌的临床分期相关(P=0.003),与性别、病理类型和肿瘤位置等因素无关,P>0.05。COX-2蛋白表达单因素分析显示,临床分期和COX-2表达水平与患者的预后有关,P<0.01。多因素分析显示,临床分期和COX-2表达水平是患者预后不良的独立因素,P<0.01。结论 COX-2的表达与食管癌的临床分期相关。COX-2的表达水平可作为老年食管鳞癌放射敏感性和预测放疗近期疗效的重要指标,临床分期和COX-2表达水平可能是影响长期生存的一个独立预后因素。
Objective To investigate the prognostic factors of esophageal squamous cell carcinoma (ESCC). The purpose of this study is to investigate the relationship between cyclooxygenase-2 (COX-2) expression and esophageal squamous cell carcinoma in elderly (≥60 years). Methods A total of 43 elderly patients with esophageal cancer undergoing radical radiotherapy at Affiliated Tumor Hospital of Zhengzhou University were enrolled in this study. All patients underwent 6 MV X-ray radiotherapy at a dose of 60 Gy. According to radiotherapy efficacy is divided into radiation-resistant group and sensitive group. The immunohistochemical SP method was used to detect COX-2 in two groups of cancerous tissues and the control analysis. Twenty healthy human tissues were selected as control group to compare the COX-2 expression level between esophageal cancer patients and control group, and to explore the relationship between COX-2 protein expression and clinical factors in esophageal squamous cell carcinoma. The relationship between COX-2 and prognosis was analyzed by single factor and multivariate analysis on the relationship between gender, clinical stage, pathological type, tumor location, COX-2 expression level, chemotherapy and survival time with 3-year overall survival rate relationship. Results The overall 3-year survival rate after radiotherapy was 23.3% (10/43). The control group COX-2 were negatively expressed in elderly (≥ 60 years) esophageal cancer group were all positive expression. The expression rates of COX-2 in radiotherapy resistant group and sensitive group were 91.67% (11/12) and 29.03% (9/31), respectively, which were significantly higher in resistant group than in sensitive group (P < 0.001. The expression of COX-2 was correlated with the clinical stage of esophageal cancer (P = 0.003), but not with the gender, pathological type and tumor location (P> 0.05). Univariate analysis of COX-2 protein expression showed that the clinical stage and the expression of COX-2 correlated with the prognosis of patients, P <0.01. Multivariate analysis showed that clinical stage and COX-2 expression level were independent prognostic factors in patients with poor prognosis (P <0.01). Conclusion The expression of COX-2 is correlated with the clinical stage of esophageal cancer. The expression of COX-2 may serve as an important indicator of the radiosensitivity of esophageal squamous cell carcinoma in elderly patients and predict the short-term efficacy of radiotherapy. The clinical stage and the expression of COX-2 may be an independent prognostic factor for long-term survival.