【作者】 汪泳；

【导师】 刘弋； 王瑞祥； 王光升；

【作者基本信息】 安徽医科大学 ， 外科学， 2003， 硕士

【摘要】 目的 研究AR，Rb和cyclinD1在胃癌组织中的表达及其相关性，同时探讨它们与临床病理因素的关系及其预后意义。方法 选取安徽医科大学第一附属医院1990～1999年经手术切除并经病理证实的早、进展期胃癌73例，并对其蜡块进行免疫组化SP法染色，检测AR，Rb和cyclinD1在胃癌组织中的表达，应用SPSS 10.0for Windows软件，统计分析它们之间的关系及其与临床病理指标、预后的关系。 结果 (1)胃癌发病年龄高峰为40～59岁；40岁之前女性胃癌发病略高于男性，而40岁以后，男性胃癌发病率显著高于女性(P＜0.05)；(2)胃癌组织中存在AR(阳性率为39.73％)；(3)胃癌组织中AR与Rb呈正相关，它们与cyclinD1无相关性；(4)AR与胃癌大小、分化程度呈负相关；Rb与胃癌浸润深度、淋巴结转移及病期呈正相关；AR，Rb与术后5年生存时间有关(P＜0.05)；cyclinD1与临床病理因素无关；(5)单变量分析显示：AR，Rb的表达、肿瘤大小、病期、淋巴结转移、浸润深度、及远处转移均影响胃癌预后；多变量分析表明，只有淋巴结转移和浸润深度是显著独立的预后指标。结论 (1)胃癌的发生随年龄增长而上升及男女在胃癌年龄分布的差异，提示除环境因素外，性激素与胃癌存在某种内在联系；(2)胃癌具有雄性激素依赖性肿瘤的特性，雄激素通过其受体对胃癌的病因、生长和控制过程起某种作用；(3)AR，Rb在胃癌的形成和发展起协同促进作用；cyclinD1可能是重要的胃癌促发因素；(4)cyclinD1的表达调控着AR，Rb对胃癌的作用；AR和Rb的过度表达协同影响胃癌生长、分化，参与胃癌进展和转移；(5)淋巴结转移、浸润深度显著影响胃癌预后；AR，Rb在一定程度上影响胃癌的预后，cyclinD1与预后无关；(6)AR阳性的胃癌为抗雄激素内分泌治疗提供参考；对于Rb阳性胃癌，术中须加强清扫淋巴结，以期彻底切除病灶；cyclinD1的异常表达可能作为潜在的早期诊断分子指标。更多还原

【Abstract】 Objective To investigate the expression of androgen receptor, retinoblastoma and cyclinDl for the purpose to evaluate their prognostic function in gastric cancer relationship. Methods Samples from 73 patients with early and advanced gastric cancer, who underwent surgical resection at First Affiliated Hospital, Anhui Medical University from 1990 to 1999, were used for this study. limmunohistochemical technique was used to detect the expression of AR, Rb and cyclinDl with SP method. The software of SPSS 10.0 was used to analyze the relationship between the expression of AR, Rb and cyclinDl with clinical parameters. Results (1) The range of the patients with gastric cancer was 40-59 years old. The incidence in female was higher than that in male with the age under 40 years, but the reverse condition presented when the age was over 40 years (P<0.05); (2) The expression of AR could be found in gastric cancer with 39.73% positive ratio; (3) The positive correlation between the expression of AR and Rb was significant, but there was no different with the expression of cyclinDl; (4) The expression of AR was negatively related to the tumor size and the grade of differentiation (P<0.05); Rb was positively related to lymph node metastasis, depth of tumor invasion and disease course (P<0.05); but there was no difference between the expression of cyclinDl and their clinical parameters; (5) Single-variate analysis indicated that all the factors including the expression of AR and Rb, lymph node metastasis, depth of tumor invasion, disease course, type of histology, size of carcinoma and far metastasis were related to the prognosis of gastric cancer; moreover, multivariate analysis indicated that lymph node metastasis and depth of tumor invasion could be use as independent prognosticfactors. Conclusion (1) The incidence of gastric cancer will go up along with the factors of age and sex, which hints that the sex hormone may related to the cause of gastric cancer besides entironment factor; (2) Gastric cancer have a character of male hormone dependence, which can accelerate the formation and progression of gastric cancer by its receptor; (3) The positive relationship between the expression of AR and Rb suggests that they might accelerate the formation and progression of gastric cancer synergistically. Their overexpression relate to the advance of gastric carcinoma. cyclinD1 may be a important factor to form gastric cancer; (4) The overexpression of cyclinDl can decrease the exression of AR and Rb; The overexpression of AR and Rb can accelerate the formation and differentiation of gastric cancer synergistically, and concern with the development and metastasis of gastric carncer. (5) Lymph node metastasis and depth of tumor invasion obviously affect the prognosis of gastric cancer, the expression of AR and Rb may become the prognosis factor of gastric cancer on a certain degree; the expression of cyclinDl can not be used as a prognosis factor on gastric cancer. (6) The expression of AR could be use as a reference for incretion therapy to resist the sex hormone; for the patient with positive expression of Rb, the clearance of lymph node should be pay attention during the operation; The overexpression of cyclinDl may be a early event in gastriccancer.更多还原