CAJ | 학술논문

目的:探讨肿瘤细胞增殖、凋亡、微血管密度及临床病理学参数对滑膜肉瘤患者复发的预后意义.方法:选择2006年1月至2009年1月期间本院临床及随访资料完整并在随访期间未见转移的滑膜肉瘤56例,采用免疫组织化学染色检测Ki-67和CD31的表达,应用TUNEL染色检测肿瘤细胞凋亡情况,比较上述因素及临床病理学参数与复发的关系,并分析它们对患者无复发生存的影响.结果:1)在随访期间41例(73.2%)患者出现复发,中位无复发生存时间为19.5个月,患者术后1、2、3、4、5年的无复发生存率分别为45.0%、41.0%、34.0%、28.0%和28.0%.2)56例滑膜肉瘤中,Ki-67标记指数为19.98%±11.64%,微血管密度为51.83±21.92个,高倍视野(×400),凋亡指数为0～9.0%.3)组织学类型(P=0.000)和微血管密度分级(P=0.045)在复发与无复发组之间差异有统计学意义.4)单因素分析结果显示,Ki-67表达(P=0.009)、组织学类型(P=0.012)、放疗(P=0.014)与滑膜肉瘤患者的无复发生存有关.5)多因素分析结果表明,组织学类型(RR=0.207,P=0.031)、Ki-67表达(RR=1.944,P=0.045)和放疗(RR=0.482,P=0.04)是滑膜肉瘤复发的独立危险因素.结论:组织学类型和微血管密度可能影响滑膜肉瘤的复发,并且组织学类型和肿瘤细胞增殖情况可能影响滑膜肉瘤患者的无复发生存.
목적:탐토종류세포증식、조망、미혈관밀도급림상병이학삼수대활막육류환자복발적예후의의.방법:선택2006년1월지2009년1월기간본원림상급수방자료완정병재수방기간미견전이적활막육류56례,채용면역조직화학염색검측Ki-67화CD31적표체,응용TUNEL염색검측종류세포조망정황,비교상술인소급림상병이학삼수여복발적관계,병분석타문대환자무복발생존적영향.결과:1)재수방기간41례(73.2%)환자출현복발,중위무복발생존시간위19.5개월,환자술후1、2、3、4、5년적무복발생존솔분별위45.0%、41.0%、34.0%、28.0%화28.0%.2)56례활막육류중,Ki-67표기지수위19.98%±11.64%,미혈관밀도위51.83±21.92개,고배시야(×400),조망지수위0～9.0%.3)조직학류형(P=0.000)화미혈관밀도분급(P=0.045)재복발여무복발조지간차이유통계학의의.4)단인소분석결과현시,Ki-67표체(P=0.009)、조직학류형(P=0.012)、방료(P=0.014)여활막육류환자적무복발생존유관.5)다인소분석결과표명,조직학류형(RR=0.207,P=0.031)、Ki-67표체(RR=1.944,P=0.045)화방료(RR=0.482,P=0.04)시활막육류복발적독립위험인소.결론:조직학류형화미혈관밀도가능영향활막육류적복발,병차조직학류형화종류세포증식정황가능영향활막육류환자적무복발생존.
Objective: To study the prognostic significance of cell proliferation and apoptosis, MVD and clinicopathologi-cal parameters for the recurrence of synovial sarcoma. Methods: We analyzed the clinical and follow-up data of 56 synovial sarcoma patients without metastasis. RT-PCR was used to detect the subtype of SYT-SSX fusion gene. The expression of Ki67 and MVD was detected by immunohistochemistry. Univariate analysis was employed to analyze the influence of the above factors and clinicopathological parameters on the recurrence free survival and to explore the influencing factors for the recurrence of synovial sarcoma. Results: Of all the patients, 73.2% (41/56) had recurrence during the follow-up. The median recurrence free survival was 19.5 months. The recurrence free 1-, 2-, 3-, 4-, and 5-year survival rates after surgery were 45.0%, 41.0%, 34.0%, 28.0%, and 28.0%, respectively. Ki-67 labeling index (LI) was 19.98%±11.64% and MVD was 51.83±21.92 per ×400. There was no significant difference in apoptotic index (AI) between the two groups (P=0.607). Χ~2 analysis showed that histological type (P=0.000) and MVD (P=0.045) were significantly correlated with the recurrence of sy-novial sarcoma. Univariate analysis showed that Ki67 LI (P=0.009), histological type (P=0.012) and radiotherapy (P= 0.014) were significantly correlated with the recurrence free survival of synovial sarcoma patients. Sex (P=0.015), tumor lo-cation (P=0.411), tumor size (P=0.801), necrosis (P=0.486), MVD (P=0.454), chemotherapy (P=0.272), and apoptotic grade (P=0.899) were not correlated with the recurrence free survival of synovial sarcoma patients. Multivariate analysis re-vealed that higher expression of Ki67 (RR=1.944, P=0.045), radiotherapy (RR=0.482, P=0.04), and histological type (RR= 0.207, P=0.031) were independent risk factors for the recurrence of synovial sarcoma. Conclusion: The expression of Ki67, radiotherapy and histological type are important factors for evaluating the recurrence and prognosis of synovial sarcoma.