CAJ | 학술논문

目的评估肾透明细胞癌组织中碳酸酐酶IX(CA IX)表达在患者预后判断中的价值.方法应用免疫组织化学P-V方法检测 120例肾透明细胞癌和25例正常肾组织石蜡标本中CA IX的表达.以肿瘤特异性生存率作为最终和主要的评估目标.运用Cox回归模型行CA IX表达与预后关系的单因素和多因素分析,以P＜0.05为差异有统计学意义.结果 112例(93.3%)获随访,随访6～94个月,中位时间45个月,无瘤生存75例,带瘤生存3例,死亡34例,其中死于肿瘤28例.正常肾组织均不表达CA IX.120例肾透明细胞癌组织中CA IX高表达89例(74.2%),高表达者中获随访82例,无瘤生存62例(75.6%),带瘤生存2例(2.4%),死亡18例(22.0%),死于肿瘤13例(15.9%),复发和(或)转移9例(11.0%),中位生存期为92个月.肾透明细胞癌CA IX低表达31例(25.8%),其中获随访30例,无瘤生存13例(43.3%),带瘤生存1例(3.3%),死亡16例(53.3%),死于肿瘤15例(50.0%),中位生存期为53个月,复发和(或)转移8例(26.7%).2组肿瘤特异性生存率比较经log-rank检验,差异有统计学意义(P=0.000,χ2=15.950),CA IX高表达组1、3、5、7年肿瘤特异性生存率分别为95.2%、83.9%、81.2%、78.2%,CA IX低表达组分别为89.5%、63.9%、46.8%、40.1%.2组术后肿瘤复发和(或)转移率比较差异有统计学意义(P=0.040,χ2=4.200).多因素Cox 回归模型分析显示CA IX表达是影响肾透明细胞癌预后的指标(RR=0.186).结论 CA IX高表达与肾透明细胞癌患者术后死亡率及肿瘤复发和(或)转移率呈负相关,CA IX可作为判断肾透明细胞癌预后的指标.
목적 평고신투명세포암조직중탄산항매IX(CA IX)표체재환자예후판단중적개치.방법 응용면역조직화학P-V방법검측 120례신투명세포암화25례정상신조직석사표본중CA IX적표체.이종류특이성생존솔작위최종화주요적평고목표.운용Cox회귀모형행CA IX표체여예후관계적단인소화다인소분석,이P＜0.05위차이유통계학의의.결과 112례(93.3%)획수방,수방6～94개월,중위시간45개월,무류생존75례,대류생존3례,사망34례,기중사우종류28례.정상신조직균불표체CA IX.120례신투명세포암조직중CA IX고표체89례(74.2%),고표체자중획수방82례,무류생존62례(75.6%),대류생존2례(2.4%),사망18례(22.0%),사우종류13례(15.9%),복발화(혹)전이9례(11.0%),중위생존기위92개월.신투명세포암CA IX저표체31례(25.8%),기중획수방30례,무류생존13례(43.3%),대류생존1례(3.3%),사망16례(53.3%),사우종류15례(50.0%),중위생존기위53개월,복발화(혹)전이8례(26.7%).2조종류특이성생존솔비교경log-rank검험,차이유통계학의의(P=0.000,χ2=15.950),CA IX고표체조1、3、5、7년종류특이성생존솔분별위95.2%、83.9%、81.2%、78.2%,CA IX저표체조분별위89.5%、63.9%、46.8%、40.1%.2조술후종류복발화(혹)전이솔비교차이유통계학의의(P=0.040,χ2=4.200).다인소Cox 회귀모형분석현시CA IX표체시영향신투명세포암예후적지표(RR=0.186).결론 CA IX고표체여신투명세포암환자술후사망솔급종류복발화(혹)전이솔정부상관,CA IX가작위판단신투명세포암예후적지표.
Objective To evaluate the prognostic significance of carbonic anhydrase IX (CA IX) expression in patients with clear cell renal cell carcinoma (ccRCC). Methods CA IX expression in a cohort of 120 patients with ccRCC was evaluated by P-V immunohistochemistry with a rabbit CA IX polyclonal antibody. Twenty-five normal kidney tissues were used as a control. The relationship between CA IX expression and prognosis was analyzed by univariate and multiple-factor analysis (Cox regression model). The primary end point was cancer specific survival. Results One hundred and twelve (93.3%) patients were followed up with the median follow-up time of 45 months (range, 6 to 94 months). Seventy-five patients survived without evidence of tumor recurrence, 3 patients survived with tumor recurrence, and 34 patients died, 28 of the 34 died of cancer. CA IX expression was negative in all normal renal tissue. High CA IX expression was observed in 89 (74.2%) patients, among which 82 patients were followed up, and the disease free survival was 75.6% (62/82). Two (2.4%) patients survived with tumor recurrence, and 18 (22.0%) patients died, of which 13 (15.9%) died of cancer. Tumor recurrence and (or) metastasis occurred in 9 (11.0%) patients, with a median survival of 92 months in this high expression group. Low CA IX expression was observed in 31 (25.8%) patients, among which 30 patients were followed up, and the disease free survival was 43.3% (13/30). One (3.3%) patient survived with tumor recurrence, and 16 (53.3%) patients died, of which 15 (50.0%) died of cancer. Tumor recurrence and (or) metastasis occurred in 8 (26.7%) patients with a median survival of 53 months in this low expression group. Cancer specific survival between CA IX high expression group and low expression group was significantly different (P=0.000, χ2=15.950), and tumor relapse and (or) metastasis rates were significantly different (P=0.040, χ2=4.200). The 1, 3, 5 and 7 year cancer specific survival rates were 95.2%, 83.9%, 81.2% and 78.2% respectively in the high CA IX expression group, and 89.5%, 63.9%, 46.8% and 40.1% respectively in the low expression group. Multivariate analysis with Cox regression model showed that CA IX expression was a prognostic factor (RR=0.186). Conclusions High CA IX expression is negatively correlated with postoperative mortality, relapse and (or) metastasis in ccRCC. CA IX expression could be used as a prognostic biomarker in ccRCC.