CAJ | 학술논문

目的初步探讨机体的慢性缺氧状态对肾透明细胞癌预后的影响. 方法应用免疫组化方法半定量检测89例肾透明细胞癌标本缺氧诱导因子-lα(HIF-lα)的表达情况.回顾性分析89例患者的临床病理资料,其中男66例,女23例；平均年龄57岁；慢性肺疾病(CPD)组19例,无慢性肺疾病(NCPD)组70例；临床分期1期46例,11期15例,Ⅲ期26例,Ⅳ期2例.并对其预后情况进行随访.用Kaplan-Meier法对是否合并慢性肺部疾病、HIF-lα表达、Hb含量、吸烟史等变量与患者生存时间进行组间分析,同时建立Cox比例风险回归模型分析各变最l与生存时间的相关性.结果 89例随访6 ～84个月,中位随访时间19个月.死亡20例,存活69例.HIF-1α阴性表达15例(16.9％),阳性表达74例(83.1％).CPD组和NCPD组疾病临床分期、血红蛋白水平及HIF-1α表达程度等方面的差异有统计学意义(P＜0.05)；两组患者中位总生存期分别为44、71个月,差异有统计学意义(P＜0.05)；Hb≤1 10 g/L组和＞1l0g/L组患者中位总生存期分别为43、70个月,差异有统计学意义(P ＜0.05)；HIF-1α的表达程度越强,总生存期越短,其差异有统计学意义(P＜0.05).合并CPD、Hb水平、HIF-1α表达是影响肿瘤患者总生存期的独立因素(P＜0.05).其中合并肺部疾病、HIF-1α表达与疾病生存时间呈正相关,Hb水平与疾病生存时间呈负相关. 结论 CPD导致的患者系统性缺氧可加重肾透明细胞癌患者的组织内缺氧状态.机体的缺氧状态与肾透明细胞癌预后存在负相关.
목적 초보탐토궤체적만성결양상태대신투명세포암예후적영향. 방법 응용면역조화방법반정량검측89례신투명세포암표본결양유도인자-lα(HIF-lα)적표체정황.회고성분석89례환자적림상병리자료,기중남66례,녀23례；평균년령57세；만성폐질병(CPD)조19례,무만성폐질병(NCPD)조70례；림상분기1기46례,11기15례,Ⅲ기26례,Ⅳ기2례.병대기예후정황진행수방.용Kaplan-Meier법대시부합병만성폐부질병、HIF-lα표체、Hb함량、흡연사등변량여환자생존시간진행조간분석,동시건립Cox비례풍험회귀모형분석각변최l여생존시간적상관성.결과 89례수방6 ～84개월,중위수방시간19개월.사망20례,존활69례.HIF-1α음성표체15례(16.9％),양성표체74례(83.1％).CPD조화NCPD조질병림상분기、혈홍단백수평급HIF-1α표체정도등방면적차이유통계학의의(P＜0.05)；량조환자중위총생존기분별위44、71개월,차이유통계학의의(P＜0.05)；Hb≤1 10 g/L조화＞1l0g/L조환자중위총생존기분별위43、70개월,차이유통계학의의(P ＜0.05)；HIF-1α적표체정도월강,총생존기월단,기차이유통계학의의(P＜0.05).합병CPD、Hb수평、HIF-1α표체시영향종류환자총생존기적독립인소(P＜0.05).기중합병폐부질병、HIF-1α표체여질병생존시간정정상관,Hb수평여질병생존시간정부상관. 결론 CPD도치적환자계통성결양가가중신투명세포암환자적조직내결양상태.궤체적결양상태여신투명세포암예후존재부상관.
Objective To explore the relationship between condition of hypoxia and prognosis in patient with renal clear cell carcinoma (RCCC).Methods The expression of hypoxia-inducible factor-lo( HIF-1 α) protein in cancer tissue of 89 RCCC cases was examined by streptavidin-biotin complex immunohistochemistry.Clinical and pathological data and prognosis of 89 cases were analyzed retrospectively.There were 66 males and 23 females,with an average age of 57 years.The patients were divided into two groups,the chronic pulmonary disease (CPD) group ( 19 cases) and non CPD (NCPD) group (70 cases),with 46cases in clinical stage I,15 cases in stage Ⅱ,26 cases in stage Ⅲ,and 2 cases in stage Ⅳ.The relationship between survival time and clinicopathological variables including the presence of CPD,the positive rate of HIF-1α protein,smoking history and hemoglobin level were evaluated by the Kaplan-Meier method.And the Cox proportional hazards regression model was build to analyze the correlation between each variable and survival time.Results The 89 cases were followed up for a median time of 19 months (6 to 84 months).Twenty cases died,and 69 cases survived.Between the CPD group and NCPD group,clinical stage,hemoglobin level and the degree of expression of HIF-1 α were significantly different (P ＜ 0.05 ).The median survival time was 44 and 71 months in CPD group and NCPD group,respectively,and the difference was significant ( P ＜ 0.05 ).The median survival time was 43 and 70 months in Hb≤ 110 g/L group and Hb ＞ 110 g/L group,respectively,and the difference was significant ( P ＜ 0.05).The stronger the degree of expression of HIF-lα was,the shorter the overall survival was.And the difference was significant ( P ＜0.05 ).Associated with CPD,hemoglobin level,the expression of H1F-1α were independent factors affecting overall survival of the patients (P ＜0.05 ).CPD and HIF-1 α expression were positively related to disease-free survival time,and hemoglobin level was negatively related to disease-free survival time.Conclusions Systemic hypoxia caused by CPD may aggravate the hypoxie state in the organization of the patients with RCCC.The condition of hypoxia and prognosis in patient with RCCC is negatively correlated.