【作者】 付允；

【导师】 孙大辉；

【作者基本信息】 吉林大学 ， 外科学， 2012， 硕士

【摘要】 目的：骨巨细胞瘤(Giant cell tumor of bone,GCT)是一种常见的原发性骨肿瘤，主要具有局部侵袭性强和复发率高的特点，可发生肺转移。同时还具有对放化疗均不敏感，且放疗后极易癌变的特点。骨巨细胞瘤主要组织学表现为弥漫增生的单核基质细胞内出现大量的多核巨细胞，肿瘤细胞成分及功能比较复杂，其病理学分级和放射学分级往往不能正确反映肿瘤的生物学行为，对于判断肿瘤细胞的侵袭性程度以及指导临床治疗带来一定困难。因此，寻找特异性标记物，对于评价骨巨细胞瘤侵袭性程度以及探讨一种有效控制侵袭性、降低复发率的临床治疗方法有着重要意义。本实验探讨MMP‐9和SOX2在骨巨细胞瘤中发生发展中的作用，并分析骨巨细胞瘤中MMP‐9和SOX2的表达定位以及表达强度与肿瘤侵袭性的相关性，为骨巨细胞瘤的生物学行为和预后判断提供依据。方法：回顾分析我院骨科2004年1月‐2010年3月接受外科手术切除的骨巨细胞瘤标本23例，其中复发肿瘤病例11例，非复发病例12例，男9例，女14例，年龄15岁‐71岁(平均年龄35岁)。肿瘤组织用40g／L多聚甲醛固定，石蜡包埋，4um连续切片等操作。通过免疫组化染色方法检测骨巨细胞瘤标本中的MMP‐9、SOX2的表达，观察其在非复发肿瘤组和复发肿瘤组中的变化。结果：1、MMP‐9在骨巨细胞瘤中阳性表达率为52.71%，与性别、年龄、发病部位、Jaffe分级不同分组中均无显著差异(P>0.05)，预后组中有显著差异(P<0.05)，表达强度与临床预后呈正相关(r=0.489，P=0.003<0.05)。2、SOX2在骨巨细胞瘤中阳性表达率为56.52%，与性别、年龄、发病部位、Jaffe分级及预后不同分组中均无显著差异(P>0.05)。3、MMP‐9、SOX2在骨巨细胞瘤中的表达无明显相关性(P>0.05)。结论：MMP‐9和SOX2在骨巨细胞瘤中均有高度表达，其中MMP‐9阳性表达与预后存在明显的正相关。表明MMP‐9可能参与了骨巨细胞瘤的发生发展，它的表达状态可能影响骨巨细胞瘤的恶性程度和预后发展，可作为定性诊断骨巨细胞瘤新的肿瘤标记物。更多还原

【Abstract】 Objective：Giant celltumorofbone(GCT)is oneofthe primarybonetumorswhichhave strong invasiveness,poorclinical therapeutic response,sarcomatous change after radiation therapy,high recurrence rate and the tendency of pulmonary metastasis.The chief histology of giant cell tumor ismany well‐distributed multinucleated giant cells which suffusion and hyperplasia can findon the background of stromal cells.Pathologic grading can’tpredictthetumor’s biologic behavior correctly, which bring problems, such as correct diagosis and treatment.So it is importanttoidentifyatumorspceific makerwhich is importantinthedesignofan interventional procedure,guiding for clinical decisions and judging prognosis.Therefore, this experiment to study the roles of MMP‐9and SOX2in developmentand progressionofbonetumors.Tostudytheexpressionlevelsof MMP‐9and SOX2ingiant celltumorofboneanddetcetthe correlationbetweentheir expression levels and the histological grade, recurrence state ofthetumor.Tointendtofind possible prognostic indicationsoftheaggressive behavioroftheunderlying pathology.Materials andmethods：23cases of bone giant cell tumor fromJanuary2004to March2010in theOrthopeadieDepartmentofthe First Hospitalof Jilin University are taken for study, among which, there are11cases recurrent tumor,12cases of non‐recurrent, and9male and14female patients aged15years to71years old (average age35years). Thetumor tissues are embedded in paraffin with40g/L paraformaldehyde,buried by paraffin and cut as4um serial sections. The expression of MMP‐9,SOX2in Giant cell tumors of bone and its changes innon‐recurrent tumor group and the recurrent tumor group are observed byimmunohistochemistry.Results：1.The positive expression rate of MMP‐9in giant cell tumor of bone was52.71%.Therewerenorelevancebetweenthe expressionof MMP‐9andgender, age, invasiveloeation, Jaffegrade(P>0.05),buttheexpressionof MMP‐9wasrelevantto prognosis(P<0.05).Expressionof MMP‐9wassignificantlyhigheringian cell tumorofbonewithrecurrencethanthatingiant celltumorofbonewithoutrecurrence.2.Thepositive expression rate of SOX2in giant cell tumor of bone was56.52%.Therewerenorelevancebetweenthe expressionof SOX2andgender, age, invasiveloeation, Jaffegrade and prognosis (P>0.05).3.Therewas no significant correlationbetweenexpressionof MMP‐9and SOX2(P>0.05).Conclusions： MMP‐9and SOX2were both highly expressed in the giant celltumor of bone.Therewassignificant correlation betweenexpressionof MMP‐9and prognosis.Theoccurrencethat expressthatthe MMP‐9may participatesGCTevolve,andaffectsthemalignantdegreeandthe prognosis progressions, which canbeusedasthenewmarkingthingsoftumortodiagnoseGCTqualitatively.更多还原