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目的:探讨尿激酶型纤溶酶原激活剂(uPA)及其受体(uPAR)在下咽癌中的表达情况及与下咽癌生物学特性及预后的关系。方法:应用免疫组织化学方法(SP法)检测48例下咽癌组织及10例正常下咽黏膜中uPA及uPAR的表达情况。采用秩和检验、Spearman等级相关分析法分析uPA及uPAR的表达与各临床病理参数之间的关系。结合术后随访资料,应用Kaplan-Meier法计算生存率。用Cox比例风险回归模型对影响下咽癌预后的风险因素进行多因素分析。结果:48例下咽癌标本中uPA表达的阳性率为77.1%,uPAR表达的阳性率为68.8%,均明显高于正常黏膜中的表达(均P<0.01)。uPA及uPAR的表达与病理分级、淋巴结转移及生长方式相关。病理分化程度越低、有淋巴结转移及浸润型生长者uPA及uPAR表达的阳性率高。结合术后随访资料分析,uPA及uPAR表达与患者预后存在相关性(P<0.05及P<0.01),经Log-rank检验,uPA表达阳性及uPAR表达阳性患者的生存率较表达阴性者低(χ2=6.41,P<0.05及χ2=12.51,P<0.01)。经Cox回归模型多因素分析发现,临床分期、浸润型生长方式和uPAR表达是影响预后的独立因素。结论:uPA及uPAR在下咽癌中的阳性表达明显上调且与患者预后存在相关性。uPAR可做为临床筛选转移的高危人群、估计下咽癌患者预后的独立而有效的生物学指标。
Objective: To investigate the expression of urokinase-type plasminogen activator (uPA) and its receptor (uPAR) in hypopharyngeal carcinoma and its relationship with the biological characteristics and prognosis of hypopharyngeal carcinoma. Methods: The expressions of uPA and uPAR in 48 cases of hypopharyngeal carcinoma and 10 cases of normal pharyngeal mucosa were detected by immunohistochemistry (SP method). The relationship between uPA and uPAR expression and clinicopathological parameters was analyzed by rank sum test and Spearman rank correlation analysis. Combined with postoperative follow-up data, Kaplan-Meier method was used to calculate the survival rate. Cox proportional hazards regression model was used to analyze the risk factors influencing the prognosis of hypopharyngeal carcinoma by multivariate analysis. Results: The positive rate of uPA expression in 48 specimens of hypopharyngeal carcinoma was 77.1%, and the positive rate of uPAR expression was 68.8%, which were significantly higher than that in normal mucosa (all P <0.01). uPA and uPAR expression and pathological grade, lymph node metastasis and growth pattern. The lower the degree of pathological differentiation, lymph node metastasis and invasive growth of uPA and uPAR expression of the positive rate. Combined with postoperative follow-up data analysis, there was a correlation between uPA and uPAR expression and prognosis (P <0.05 and P <0.01). Log-rank test showed that the survival rate of patients with positive uPA expression and uPAR expression was lower than those with negative expression χ2 = 6.41, P <0.05 and χ2 = 12.51, P <0.01). Multivariate analysis by Cox regression model found that clinical stage, invasive growth pattern and uPAR expression were independent prognostic factors. Conclusion: The positive expression of uPA and uPAR in hypopharyngeal carcinoma was significantly up-regulated and correlated with the prognosis of patients. uPAR can be used as an independent and effective biological indicator for estimating the prognosis of patients with hypopharyngeal carcinoma as a high-risk population for clinical screening and metastasis.