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目的研究生存素(Survivin)、环氧合酶-2(COX-2)和血管内皮生长因子(VEGF)在胃癌组织中的表达,探讨它们表达的关系及其与胃癌预后的关系。方法选取淮南东方医院集团总医院1992~2002年10年间行根治性手术治疗,临床、病理和随访资料齐全的胃癌患者65例,应用免疫组化S-P技术,检测Survivin、COX-2和VEGF在胃癌组织中表达。结果早期胃癌的5年生存率为95.2%(20/21),中期胃癌的5年生存率为63.6%(7/11)。中期胃癌组Survivin阳性表达高于早期胃癌组(73.6%vs 66.7%,P<0.05),其VEGF阳性表达和微血管密度(MVD)平均值高于早期胃癌组(P<0.05)。Survivin和COX-2在慢性萎缩性胃炎中的表达明显低于不典型增生者(P<0.05),在癌组织中的表达明显高于非癌组织(P<0.05)。胃癌组中的VEGF阳性表达率和MVD平均值均明显高于非癌组,且与胃癌浸润深度有关(P<0.05)。胃癌中Survivin、VEGF阳性表达的MVD值显著高于Survivin、VEGF阴性表达者(P<0.05);Survivin、COX-2、VEGF及MVD值与胃癌淋巴结转移、血管浸润均密切相关(P<0.05);Survivin、COX-2阳性表达及VEGF阳性表达者5年生存率明显低于阴性或低表达者(P<0.05)。多因素分析显示,淋巴结转移、浸润深度、Survivin表达、VEGF表达均为胃癌独立的预后因素。结论Survivin、COX-2、VEGF与胃癌的生长和浸润转移关系密切,可以作为反映胃癌生物学行为和判断预后的有效指标。
Objective To investigate the expression of Survivin, COX-2 and VEGF in gastric carcinoma and their relationship with the prognosis of gastric cancer. Methods Totally 65 cases of gastric cancer patients with complete clinical, pathological and follow-up data from 1992 to 2002 in Huainan Dongfang Hospital Group General Hospital were enrolled in this study. The expressions of Survivin, COX-2 and VEGF were detected by immunohistochemical SP method in gastric cancer Tissue expression. Results The 5-year survival rate of early gastric cancer was 95.2% (20/21) and the 5-year survival rate of intermediate gastric cancer was 63.6% (7/11). The positive expression of Survivin in gastric cancer group was higher than that in early gastric cancer group (73.6% vs 66.7%, P <0.05). The mean value of VEGF expression and microvessel density (MVD) in gastric cancer group was higher than that in early gastric cancer group (P <0.05). The expression of Survivin and COX-2 in chronic atrophic gastritis was significantly lower than that in atypical hyperplasia (P <0.05), and was significantly higher in non-cancerous tissues than in non-cancerous tissues (P <0.05). The positive expression rate of VEGF and MVD in gastric cancer group were significantly higher than non-cancer group, and the depth of invasion of gastric cancer (P <0.05). The MVD values of Survivin and VEGF in gastric cancer were significantly higher than those in Survivin and VEGF (P <0.05). Survivin, COX-2, VEGF and MVD in gastric cancer were closely related to lymph node metastasis and vascular invasion (P <0.05) The 5-year survival rates of Survivin, COX-2 and VEGF-positive were significantly lower than those of negative or low expression (P <0.05). Multivariate analysis showed that lymph node metastasis, depth of invasion, Survivin expression, VEGF expression were independent prognostic factors of gastric cancer. Conclusions Survivin, COX-2 and VEGF are closely related to the growth, invasion and metastasis of gastric cancer, which can be used as an effective indicator of biological behavior and prognosis of gastric cancer.