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目的探讨食管鳞癌组织中Survivin蛋白表达水平对同步放化疗效果的影响。方法选取2009年10月至2012年6月间甘肃省肿瘤医院收治的行同步放化疗治疗的62例局部晚期食管鳞癌初治患者,采用免疫组织化学法检测患者病理组织中Survivin蛋白的表达水平,分析Survivin蛋白表达对放化疗患者近期和远期疗效的影响。结果局部晚期食管鳞癌患者Survivin蛋白阳性表达率为56.5%(35/62)。Survivin蛋白表达与患者肿瘤分化程度和临床分期相关,差异均有统计学意义(均P<0.05),与患者年龄、性别及ZPS评分等无关,差异均无统计学意义(均P>0.05)。患者客观有效率(ORR)为80.6%(50/62),疾病控制率(DCR)为98.4%(61/62)。其中,Survivin蛋白阳性者ORR为82.9%(29/35),阴性者ORR为81.5%(22/27),两组比较,差异有统计学意义(P<0.01)。Survivin蛋白阳性者和阴性者DCR分别为97.1%(34/35)和100.0%(27/27),差异有统计学意义(P<0.01)。所有患者中位总生存时间(OS)为28个月,且1、2和3年生存率分别为95.2%(59/62)、62.9%(39/62)和38.7%(24/62),其中,Survivin蛋白阳性者1、2和3年生存率分别为94.3%(33/35)、62.9%(22/35)和37.1%(13/35),Survivin蛋白阴性者分别为96.3%(26/27)、63.0%(17/27)和40.7%(11/27)。Kaplan-Meier生存分析显示,两组患者OS间差异有统计学意义(2=3.85,P<0.05)。结论 Survivin蛋白表达与肿瘤分化程度和TNM分期有关,食管鳞癌组织中Survivin蛋白阴性患者放化疗的敏感性较高,且预后好。
Objective To investigate the effect of Survivin protein expression on the efficacy of concurrent chemoradiotherapy in esophageal squamous cell carcinoma. Methods Sixty-two patients with locally advanced esophageal squamous cell carcinoma who underwent concurrent chemoradiotherapy from October 2009 to June 2012 in Gansu Provincial Cancer Hospital were enrolled. The expression of Survivin protein in the pathological tissues was detected by immunohistochemistry , Analysis of Survivin protein expression of patients with radiotherapy and chemotherapy in the short and long term effects. Results The positive rate of Survivin protein in locally advanced esophageal squamous cell carcinoma was 56.5% (35/62). Survivin protein expression was correlated with the degree of tumor differentiation and clinical stage in patients (all P <0.05), but not with the age, gender and ZPS scores. There was no significant difference (P> 0.05). The objective response rate (ORR) was 80.6% (50/62) and the disease control rate (DCR) was 98.4% (61/62). Among them, the positive rate of Survivin protein was 82.9% (29/35), while the negative rate was 81.5% (22/27). There was significant difference between the two groups (P <0.01). The DCR of Survivin positive and negative patients were 97.1% (34/35) and 100.0% (27/27), respectively, with significant difference (P <0.01). The median overall survival (OS) was 28 months for all patients and 95.2% (59/62), 62.9% (39/62), and 38.7% (24/62) for 1, 2, The 1, 2 and 3-year Survivin protein positive rates were 94.3% (33/35), 62.9% (22/35) and 37.1% (13/35), respectively. The Survivin protein negative rates were 96.3% /27),63.0% (17/27) and 40.7% (11/27). Kaplan-Meier survival analysis showed that the OS between the two groups was statistically significant ( 2 = 3.85, P <0.05). Conclusion The expression of Survivin protein is correlated with the degree of tumor differentiation and TNM staging. Survivin protein-negative patients with esophageal squamous cell carcinoma are more sensitive to radiotherapy and chemotherapy, and the prognosis is good.