Notch 4表达与胸中段食管鳞癌侵袭、转移及预后的关系

摘要

Objective To investigate the expression of Notch 4 in esophagus squamous cell carcinoma and its relationship with clinicopathological significance and prognosis.Methods A retrospective study was performed of 97 patients with midthoracic esophageal squamous carcinoma who accepted surgical treatment from 2007 to 2010.The expression of Notch 4 was examined by immunohistochemistry.The survival rate was calculated by Kaplan-meier method and the difference was determined by the log-rank analyze.The cox regression analysis was performed to determine the independent risk factors for lymph-metastastic recurrence.Results Notch 4 protein expression was detected in 42 patients of 97 with positive rate of 45.2％.The positive rate of Notch 4 in T1,T2,T3 and T4 patients was separately 66.7 ％ 、54.5 ％ and 28.6％ with significant difference(P =0.009).The positive rate of Notch 4 expression in NO and N1 patients was separately 57.1％ and 29.2％ with significant difference(P =0.005).the positive rate of Notch 4 expression in low-middle differentiation and high differentiation patients was separately 31.3 ％ and 56.3 ％ with significant difference (P =0.006).the 5-year survival rate of patients with Notch 4expression and without Notch 4 expression was separately 47.6％ and 18.2％ with significant difference(P =0.000).The Cox regression analysis showed that the negative expression of Notch 4 and the lymphometastasis were independent risk factors.Conclusion The low expression of Notch 4 protein was detected in esophagus squamous cell carcinoma and had a correlation with the differentiation,T classification and lmphometastasis.Cox regression analysis showed that the low expression of Notch 4protein is an independent risk factor and can be a biomarker of poor prognosis.%目的 探讨Notch 4在食管鳞癌中的表达与临床病理及患者预后的关系.方法 对2007年至2010年间手术治疗的97例胸中段食管鳞癌患者进行回顾性研究.免疫组织化学染色方法检测Notch 4在肿瘤组织中的表达.采用x2检验判断相关性、Kaplan-meier法进行生存分析、Log-rank检验判断生存差异性,应用Cox比例风险模型进行多因素分析判定独立预后因素.P＜0.05为差异有统计学意义.结果 97例中42例伴有Notch 4阳性表达,占病例总数的43.3％.食管鳞癌组织中Notch 4的阴性表达与肿瘤分化程度(P =0.006)、浸润深度(P=0.009)及淋巴结转移(P =0.005)相关.97例5年生存率为30.9％,Notch 4表达阴性患者为18.2％,Notch 4表达阳性患者为47.6％,两者差异有统计学意义(P =0.000).Cox回归分析显示淋巴结转移及Notch 4的阴性表达是胸中段食管癌术后独立的预后危险因素.结论 在食管鳞癌中伴有Notch 4的表达下调,且可能与肿瘤的分化程度、T分期及淋巴结转移相关.伴有Notch 4表达阴性患者的5年生存率明显低于表达阳性患者,Notch 4可能作为评估患者预后的分子生物学指标.