【作者】 杨飞；

【导师】 邓跃华； 刘弋； 常家聪；

【作者基本信息】 安徽医科大学 ， 外科学， 2014， 硕士

【摘要】 目的:通过检测胃癌组织及相应癌旁组织中异黏蛋白（MTDH）和程序性细胞死亡因子4（PDCD4）的表达，分析MTDH和PDCD4在胃癌组织中的表达及其临床意义，探讨其在胃癌发生、发展中的作用。方法:应用免疫组化二步法检测83例原发性胃癌患者术后癌组织及相应癌旁组织标本中MTDH和PDCD4的表达，分析二者的表达与胃癌的发生、发展和临床病理参数及预后的关系，所有数据使用SPSS13.0统计软件进行分析处理。结果：1.MTDH的表达情况MTDH在胃癌组织和癌旁组织中均可见到阳性表达，在胃癌组织中MTDH的阳性表达率为61.4%，高于其在癌旁组织中表达率34.9%，差异显著，二者比较有统计学意义（χ2=11.678，P＜0.01）；MTDH在胃癌组织中的阳性表达与肿瘤的浸润程度、有无淋巴结转移以及分期显著相关，差别比较有统计学意义(P＜0.05)，肿瘤局限于黏膜和肌层者阳性表达率明显低于侵及浆膜及浆膜外者(χ2=5.329，P=0.021)，有淋巴结转移者阳性表达率明显高于无淋巴结转移者(χ2=5.853，P=0.016)，TNM分期分组中Ⅰ＋Ⅱ期组阳性表达率明显低于Ⅲ＋Ⅳ期组(χ2=7.757，P=0.005)，与其他组别的临床病理参数差别无统计学意义（P＞0.05）。2.PDCD4的表达情况PDCD4在胃癌组织和癌旁组织中均有阳性表达，在胃癌组织中PDCD4的阳性表达率为30.1%，低于其在癌旁组织中的阳性表达率为73.5%，差别比较有统计学意义（χ2=31.270，P＜0.001）；PDCD4在胃癌组织中的阳性表达水平与肿瘤的分化程度显著相关，高、中分化型胃癌组表达率高于低分化型胃癌组（χ2=4.953，P=0.026），与其他组别的临床病理参数差别无统计学意义（P＞0.05）。3. MTDH与PDCD4在胃癌组织中的表达与预后随访资料统计显示，MTDH阳性表达组患者一年、三年、五年的生存率分别为81.9%、51.2%、25.6%；MTDH阴性表达组患者一年、三年、五年的生存率分别为96.7%、78.2%、56.1%，两者比较差别有统计学意义(χ2=6.497，P=0.011)。PDCD4阳性表达组患者一年、三年、五年的生存率分别为87.8%、70.8%、37.5%；PDCD4阴性表达组患者一年、三年、五年的生存率分别为87.6%、57.5%、31.1%，两组比较差别无统计学意义(χ2=1.644，P=0.200)。4.MTDH与PDCD4在胃癌组织中的表达相关性在51例MTDH阳性表达的胃癌组织中有7例PDCD4阳性表达，阳性表达率为13.7%，在32例MTDH阴性表达的胃癌组织中有18例PDCD4阳性表达，阳性表达率为56.3%。采用分类变量的关联性分析示MTDH和PDCD4的表达存在关联(χ2=16.893，P＜0.05，r=-0.451)。结论：1.MTDH在胃癌组织中的表达明显高于癌旁组织，提示MTDH具有原癌基因的特点，参与了胃癌的发生、发展。2.MTDH在胃癌组织中的表达反映出胃癌浸润发展的程度，有望成为胃癌新的肿瘤标记物，有助于胃癌的诊断、治疗及判断预后。3.PDCD4在胃癌组织中低表达或不表达，而在癌旁组织中高表达，说明PDCD4在胃癌的发生、发展过程中起重要作用。4.PDCD4在胃癌组织中的表达与癌组织分化程度密切相关，检测PDCD4可作为判断胃癌恶性程度的指标，但PDCD4的表达不能作为判断胃癌预后的指标。5.胃癌组织中MTDH和PDCD4表达呈负相关，两者共同作用于胃癌的发生、发展。更多还原

【Abstract】 Objective To detect the expression of metadherin(MTDH)and programmed cell death4(PDCD4)in the gastric cancer tissues and the corresponding paracancer tissues,analysisthe expression of them in the gastric cancer tissues and their clinical significance,toexplore the role of them in the occurrence and development of gastric cancer.Methods The expressions of MTDH and PDCD4were detected in83cases of primarygastric cancer patients cancer tissue and the corresponding paracancer tissues byTwo-step immunohistochemical method.Analysis the relationship between theexpression of them and the occurrence,development, clinical pathological parametersand prognosis in gastric cancer, all the data were processed by SPSS13.0.Results1. The expression of MTDH The positive expression of MTDH can be found both ingastric cancer tissues and the corresponding paracancer tissues, the positive expressionrate of MTDH in gastric cancer tissues was61.4%,which was higher than that the rateof the expression in the corresponding paracancer tissues61.4%, the difference wasstatistically significant(χ2=11.678,P<0.01);The expression of MTDH was statisticallysignificant associated with the depth of invasion, lymph node metastasis and clinicalstage(P<0.05), the positive expression of MTDH in the mucosa and muscularis groupwas lower than the serosa and serosa outside group(χ2=5.329,P=0.021),the positiveexpression of MTDH in lymph node metastasis was significantly higher than thosewithout lymph node metastasis(χ2=5.853,P=0.016),the positive expression of MTDH in groupⅠandⅡof TNM stage was significantly lower than that in group III and IV(χ2=7.757,P=0.005),nothing to do with other clinicopathological parameters(P>0.05).2. The expression of PDCD4The positive expression of PDCD4can be found both ingastric cancer tissues and the corresponding paracancer tissues, the positive expressionrate of PDCD4in gastric cancer tissues was30.1%,which was lower than that the rate ofthe expression in the corresponding paracancer tissues73.5%, the difference wasstatistically significant(χ2=31.270,P<0.001). The expression of PDCD4was statisticallysignificant associated with degree of differentiation, the positive expression of PDCD4in high differentiated gastric cancer group was higher than that in low differentiatedgastric cancer group(χ2=4.953,P=0.026),nothing to do with other clinicopathologicalparameters(P>0.05).3. The expression of MTDH and PDCD4in gastric cancer and prognosis TheStatistics show that the positive expression of MTDH group one year, three year, fiveyear survival rates were81.9%,51.2%,25.6%;The negative expression of MTDH groupone year, three years, five years survival rate were96.7%,78.2%,56.1%, the differencewas statistically significant (χ2=6.497,P=0.011).The positive expression of PDCD4group one year, three year, five year survival rates were87.8%,70.8%,37.5%;Thenegative expression of PDCD4group one year, three years, five years survival rate were87.6%,57.5%,31.1%, the difference was not statistically significant (χ2=1.644,P=0.200).4. The correlation between the expressions of MTDH and PDCD4in gastric cancerThere were7cases of PDCD4positive expression in the51cases of MTDH positiveexpression in gastric cancer, the positive expression rate was13.7%, there were18cases of of PDCD4positive expression in the32cases of MTDH negative expression ingastric cancer, the positive expression rate was56.3%. There was negative correlationbetween the expressions of MTDH and PDCD4in gastric cancer tissue(χ2=16.893,P<0.05,r=-0.451). Conclusion1.The expression of MTDH in gastric cancer was significantly higher than that in thecorresponding paracancer tissues, suggesting that MTDH has the characteristics of theproto-oncogene and involved in the occurrence and development of gastric cancer.2.The expression of MTDH in gastric cancer reflects the degree of development ofgastric cancer, which is expected to become a new tumor marker for gastric cancer, it ishelpful to the diagnosis, treatment and prognosis of gastric cancer.3.The expression of PDCD4in gastric cancer was significantly lower than that in thecorresponding paracancer tissues, indicating that PDCD4plays an important role in theoccurrence and development of gastric cancer.4.The expression of PDCD4was statistical significance associated with degree ofdifferentiation,which can be used to judge the malignant degree of gastric cancer, Butthe expression of PDCD4was unable to judge the prognosis of gastric cancer.5.There is a negative correlation between MTDH and PDCD4, the expressions of themare closely related with the occurrence and development of gastric cancer.更多还原