CAJ | 학술논문

目的探讨胆囊良恶性病变组织中MK-1抗原(MK-1)和再生基因蛋白Ⅳ(RegⅣ)的表达水平及其临床病理意义。方法 108例胆囊腺癌、46例癌旁组织、15例腺瘤性息肉和35例慢性胆囊炎手术切除标本常规制作石蜡包埋切片,MK-1和RegⅣ染色方法均为EnVisionTM免疫组织化学方法。结果胆囊腺癌MK-1和RegⅣ表达阳性率均明显高于癌旁组织(x2MK-1=18.76,P＜0.01;x2RegⅣ=9.92,P＜0.01)、腺瘤性息肉(x2MK-1=9.49,P＜0.01;x2RegⅣ=8.59,P＜0.01)和慢性胆囊炎(x2MK-1=24.11,P＜0.01;x2RegⅣ=19.24,P＜0.01);MK-1和RegⅣ表达阳性的良性病例的胆囊上皮均呈中至重度不典型增生。高分化、无淋巴结转移、未侵犯周围组织的病例MK-1表达阳性率明显高于低分化、淋巴结转移和侵犯周围组织的病例(P＜0.05或P＜0.01);高分化腺癌、无淋巴结转移和未侵犯周围组织的病例RegⅣ表达阳性率明显低于低分化腺癌、淋巴结转移和侵犯周围组织病例(P＜0.05或P＜0.01)。经Kaplan-Meier生存分析发现MK-1表达阳性病例术后生存期明显高于阴性表达病例(P＜0.01),但RegⅣ表达阳性病例术后生存期明显低于阴性表达病例(P＜0.01);Cox多变量回归分析显示,MK-1阴性表达和(或)RegⅣ阳性表达可反映胆囊腺癌预后不良。结论 MK-1和RegⅣ表达与胆囊腺癌发生、临床生物学行为及预后密切相关。
목적 탐토담낭량악성병변조직중MK-1항원(MK-1)화재생기인단백Ⅳ(RegⅣ)적표체수평급기림상병리의의。방법 108례담낭선암、46례암방조직、15례선류성식육화35례만성담낭염수술절제표본상규제작석사포매절편,MK-1화RegⅣ염색방법균위EnVisionTM면역조직화학방법。결과 담낭선암MK-1화RegⅣ표체양성솔균명현고우암방조직(x2MK-1=18.76,P＜0.01;x2RegⅣ=9.92,P＜0.01)、선류성식육(x2MK-1=9.49,P＜0.01;x2RegⅣ=8.59,P＜0.01)화만성담낭염(x2MK-1=24.11,P＜0.01;x2RegⅣ=19.24,P＜0.01);MK-1화RegⅣ표체양성적량성병례적담낭상피균정중지중도불전형증생。고분화、무림파결전이、미침범주위조직적병례MK-1표체양성솔명현고우저분화、림파결전이화침범주위조직적병례(P＜0.05혹P＜0.01);고분화선암、무림파결전이화미침범주위조직적병례RegⅣ표체양성솔명현저우저분화선암、림파결전이화침범주위조직병례(P＜0.05혹P＜0.01)。경Kaplan-Meier생존분석발현MK-1표체양성병례술후생존기명현고우음성표체병례(P＜0.01),단RegⅣ표체양성병례술후생존기명현저우음성표체병례(P＜0.01);Cox다변량회귀분석현시,MK-1음성표체화(혹)RegⅣ양성표체가반영담낭선암예후불량。결론 MK-1화RegⅣ표체여담낭선암발생、림상생물학행위급예후밀절상관。
Objective To study the expression levels of MK-1 antigen and regenerating gene Ⅳ (RegⅣ) and their clinicopathological significance in the benign and malignant lesions of gallbladder.Methods EnVisionTM immunohistochemical method for determining the expression of MK-1 and RegⅣ was used in routinely paraffin-embedded sections of surgically resected specimens from gallbladder adenocarcinoma ( n =108 ), peritumoral tissues ( n =46), adenomatous polyp ( n =15 ), and chronic cholecystitis (n =35). Results The positive rate of MK-1 or RegⅣ expression was significantly higher in gallbladder adenocarcinoma than that in peritumoral tissues (x2MK-1 =18.76, P ＜ 0. 01 ;x2RegⅣ =9.92, P ＜ 0. 01 ),adenomatous polyp (x2MK-1 =9. 49, P ＜ 0. 01 ;x2RegⅣ =8.59, P ＜ 0. 01 ) and chronic cholecystitis (x2MK-1 =24. 11,P ＜0. 01;x2RegⅣ =19. 24,P ＜ 0. 01 ). The positive cases of MK-1 and/or RegⅣ in the benign lesions showed moderate-or severe-atypical hyperplasia of gallbladder epithelia. The positive rate of MK-1 was significantly higher in the cases of well-differentiated adenocarcinoma, no-metastasis of lymph node,and no-invasiveness of regional tissues than that in the cases of low-differentiated adenocarcinoma, metastasis of lymph node, and invasiveness of regional tissues in gallbladder adenocarcinoma ( P ＜ 0. 05 or P ＜0. 01 ). The positive rate of RegⅣ was significantly lower in the cases of well-differentiated adenocarcinoma,no-metastasis of lymph node, and no-invasiveness of regional tissues than those in the cases of low-differentiated adenocarcinoma, metastasis of lymph node, and invasiveness of regional tissues in gallbladder adenocarcinoma (P ＜0. 05 or P ＜0. 01 ). Unitivariate Kaplan-Meier analysis revealed that the decreased expression of MK-1 (P ＜0. 01 ) or increased expression of RegⅣ (P ＜0. 01 ) was associated with decreased overall survival. Multivariate Cox regression analysis demonstrated that the decreased expression of MK-1 (P ＜ 0. 05 )and/or increased expression of RegⅣ (P ＜0. 01 ) was an independent bad-prognostic predictor in gallbladder adenocarcinoma. Conclusion The expression of MK-1 and/or RegⅣ might be closely related to the carcinogenesis, clinical biological behaviors, and prognosis of gallbladder adenocarcinoma.