细胞周期蛋白D1和bax影响壶腹周围腺癌胰十二指肠切除术后的预后。

Cyclin D1 and bax influence the prognosis after pancreatoduodenectomy for periampullary adenocarcinoma.

作者信息

Tomazic Ales, Pegan Vladislav, Ferlan-Marolt Ksaverija, Pleskovic Alojz, Luzar Bostjan

机构信息

Department of Abdominal Surgery, University Medical Centre Ljubljana, Slovenia.

出版信息

Hepatogastroenterology. 2004 Nov-Dec;51(60):1832-7.

PMID:15532837

Abstract

BACKGROUND/AIMS: The outcome of patients undergoing pancreatoduodenectomy for periampullary adenocarcinoma is influenced by various clinicopathological factors, chemo/radiotherapy and expression of various oncogenes, tumor suppressor genes, growth factors and factors controlling apoptosis. The aim of this study was to define clinicopathological predictors of survival in periampullary adenocarcinoma, and to determine the prognostic significance of cyclin D1, p27kip1 and bax expression in these tumors.

METHODOLOGY

Prospectively, we collected clinicopathological data for patients operated on between January 1995 and December 1998. Cyclin D1, p27kip1 and bax expression was assessed immunohistochemically. The potential influence of clinicopathological factors and cyclin D1, p27kip1 and bax expression on survival was investigated. Univariate analyses were performed using the Kaplan-Meier method and log-rank test. For multivariate analysis Cox proportional hazards regression was used.

RESULTS

Fifty-five patients were included in the study. The actuarial 5-year survival was 30%: 11% for pancreatic adenocarcinoma and 46% for distal bile duct/papillary adenocarcinoma Univariate analysis identified diabetes mellitus, blood transfusion, diameter of the tumor, histological type of the tumor, lymphatic invasion, neural invasion, lymph node metastasis, overexpression of cyclin D1 and lower expression of bax and p27kip1 as factors that significantly decrease survival rates. In multivariate analysis, the histological type of the tumor (p=0.001), lymph node involvement (p=0.03) and overexpression of cyclin D1 (p=0.02) independently influenced survival, whereas decreased expression of bax nearly reached statistical significance (p=0.054).

CONCLUSIONS

Our findings confirm the association between cyclin D1 and bax expression and aggressive biological behavior of periampullary adenocarcinomas. Moreover, these parameters were identified as independent prognostic indicators in these tumors.

摘要

背景/目的：接受胰十二指肠切除术治疗壶腹周围腺癌的患者的预后受到多种临床病理因素、化疗/放疗以及各种癌基因、肿瘤抑制基因、生长因子和控制细胞凋亡的因子表达的影响。本研究的目的是确定壶腹周围腺癌生存的临床病理预测指标，并确定细胞周期蛋白D1、p27kip1和bax表达在这些肿瘤中的预后意义。

方法

前瞻性地收集了1995年1月至1998年12月接受手术的患者的临床病理数据。采用免疫组织化学方法评估细胞周期蛋白D1、p27kip1和bax的表达。研究了临床病理因素以及细胞周期蛋白D1、p27kip1和bax表达对生存的潜在影响。使用Kaplan-Meier法和对数秩检验进行单因素分析。多因素分析采用Cox比例风险回归。

结果

55例患者纳入本研究。精算5年生存率为30%：胰腺腺癌为11%，远端胆管/乳头状腺癌为46%。单因素分析确定糖尿病、输血、肿瘤直径、肿瘤组织学类型、淋巴管浸润、神经浸润、淋巴结转移、细胞周期蛋白D1过表达以及bax和p27kip1低表达是显著降低生存率的因素。多因素分析中，肿瘤组织学类型（p=0.001）、淋巴结受累情况（p=0.03）和细胞周期蛋白D1过表达（p=0.02）独立影响生存，而bax表达降低接近统计学意义（p=0.054）。