目的 探讨细胞质胸苷激酶1(cytosolic thymidine kinase 1,TK1)在TNM病理分期T1期(pT1)肺腺癌中的表达及预后意义.方法 选择具有完整临床病理及随访资料结果的pT1期肺腺癌80例,应用免疫组织化学方法(EnVision法)检测TK1的表达情况,研究TK1表达与临床病理特征的关系,并分析该指标本身及与间质浸润分级相结合对肿瘤预后的评估作用.结果 TK1表达:12例(15%)表达"-",27例(33.8%)表达"+",31例(38.8%)表达"(++)",10例(12.5%)表达"(+++)".5年存活者:TK1"-"(87.5%)与"+"(82.1%)相似,"(++)"(35%)与"(+++)"(51.3%)相似,其余各表达强度病例间均有差异.据此将本组病例分为预后好的TK1"-/+"表达组(41例)以及预后差的TK1"(++)/(+++)"表达组(39例).TK1"(++)/(+++)"表达组的淋巴管/血管侵犯率(P=0.019)、淋巴结转移率(P=0.002)、间质浸润分级(P＜0.001)及临床病理分期(P＜0.001)均高于TK1"-/+"表达组,性别、年龄、肿瘤直径及吸烟史两组间的差异无统计学意义.本组病例的间质浸润分级:0级:7例(9%),1级:10例(12%),2级:12例(15%),3级:51例(64%),间质浸润分级0级、1级及2级病例的预后相似并好于3级病例,而3级病例中TK1表达"-/+"者的5年生存率高于TK1表达"(++)/(+++)"者(P=0.006),且与0～2级病例相似.结论 pT1期肺腺癌中TK1表达与肿瘤侵袭性及预后密切相关,并可与间质浸润分级相结合对肿瘤预后进行更加准确的评估.%Purpose To explore the expression and the prognostic significance of cytosolic thymidine kinase 1 ( TK1 ) in pathologicalT1 ( pT1 ) adenocarcinoma of the lung. Methods Eighty cases of surgically resected pT1 lung adenocarcinoma, including clinicopathologic and follow-up data, were studied retrospectively. The expression of TK1 was detected in all the cases by immunohistochemical techniques. The relation between the expression of TK1 and clinicopathologic characteristics were investigated, and the prognostic role of this marker and its combination with stromal invasion grade was also analyzed. Results In these cases, there were 12 ( 15％ ) cases with " - " , 27 ( 33. 8％ ) cases with " + " , 31 ( 38. 8％ ) cases with "++" and 10 ( 12. 5％ ) cases with "+++" TK1-expression. The statistically significant difference of the 5-year survival rate was found between any two groups of cases with different expression level of TK1, except the cases with " - " expression ( 87. 5％ ) and " + " expression ( 82. 1％ ), the cases with "++" expression ( 35％ ) and "+++" expression ( 51. 3％ ). Accordingly these cases were classified into two groups, including " -/ + " TK1-expression group with better prognosis and "++/+++" TK1-expression group with poor prognosis. The lymphatic/vascular invasion rate ( P = 0. 019 ), the lymph node involvement rate ( P = 0. 002 ), the stromal invasion grade ( P ＜ 0. 001 ) and the pathologic stage ( P ＜ 0. 001 ) in the cases with "++/+++ " TK1-expression were higher than those with " -/ + " TK1-expression. There were no significant differences of age, gender, tumor diameter and smoking history between these two groups. The distribution of stromal invasion grade ( 0 ～ 3 ) was as follows :7 ( 8％ ) cases in grade 0. 10 ( 12％ ) cases in grade 1, 12 ( 14％ ) cases in grade 2, and 56 ( 66％ ) cases in grade 3. The prognosis of the cases with grade 0, grade 1 and grade 2 stromal invasion was similar and better than that of the cases with grade 3. In the cases with grade 3 , the 5-year survival rate in patients with " -/ + " TK1-expression was higher than that with "++/+++" TK1-expression ( P = 0. 006 ), and similar to that of the cases with grades 0 ～2. Conclusion For pT1 adenocarcinoma of the lung, TK1 expression profile is closely related to tumor invasion and prognosis. It can be combined with stromal invasion grade to accurately evaluate the progno SiS.
展开▼
