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目的存活素(Survivin)和尿激酶型纤溶酶原激活剂(urokinase plasminogen activator,uPA)在胰腺癌侵袭转移过程中发挥重要作用。本研究通过联合检测Survivin和uPA在胰腺癌中的表达,探讨两者在评估胰腺癌预后的临床价值。方法选取2000-01-01-2007-12-01兰州军区乌鲁木齐军区总医院肝胆外科手术切除的63例原发性胰腺癌组织作为样本。采用免疫组化法检测Survivin和uPA蛋白在胰腺癌组织中的表达,并分析其与胰腺癌患者临床病理特征和预后的相关性。结果 Survivin和uPA蛋白与患者分化程度(χ~2=20.607,P<0.001;χ~2=11.529,P=0.003)、TNM分期(χ~2=8.679,P=0.034;χ~2=15.166,P=0.002)及是否淋巴结转移(χ~2=5.377,P=0.020;χ~2=10.101,P=0.001)均有关。Survivin与uPA的表达呈正相关(r=0.389,P=0.002)。Kaplan-Meier生存曲线结果显示,Survivin(-)组患者1年累计生存率(86.7%)及中位生存期(21个月)均高于Survivin(+)组患者(22.0%,9个月),差异有统计学意义,χ~2=29.893,P<0.001。uPA(-)组患者1年累计生存率(90.0%)及中位生存期(18个月)均高于uPA(+)组患者(5.9%,9个月),差异有统计学意义,χ~2=41.495,P<0.001。Survivin(-)/uPA(-)组患者术后生存期均高于其他组,差异有统计学意义,χ~2=52.453,P<0.001。Cox多因素分析结果表明,淋巴结转移(P=0.018)、Survivin(P<0.001)和uPA过表达(P<0.001)是影响胰腺癌预后的独立相关因子。结论在胰腺癌发生发展侵袭和转移过程中Survivin与uPA蛋白之间存在某种协同关系,联合检测两者的表达可能更确切反映胰腺癌的预后及作为淋巴结转移判断胰腺癌预后的补充。
Survivin and urokinase plasminogen activator (uPA) play an important role in the invasion and metastasis of pancreatic cancer. This study through the joint detection of Survivin and uPA expression in pancreatic cancer, to explore the two in the evaluation of the clinical value of the prognosis of pancreatic cancer. Methods Totally 63 cases of primary pancreatic cancer resected from hepatobiliary surgery in Urumchi Military General Hospital of Lanzhou Military Region from January 2000 to January 2007 were selected as samples. Immunohistochemistry was used to detect the expression of Survivin and uPA protein in pancreatic cancer, and its correlation with clinicopathological features and prognosis of pancreatic cancer was analyzed. Results There was significant difference in the expression of Survivin and uPA protein between the patients with TNM stage (χ ~ 2 = 8.679, P = 0.034; χ ~ 2 = 15.166, P = 0.002) and lymph node metastasis (χ ~ 2 = 5.377, P = 0.020; χ ~ 2 = 10.101, P = 0.001). Survivin and uPA expression was positively correlated (r = 0.389, P = 0.002). Kaplan-Meier survival curves showed that the 1-year cumulative survival rate (86.7%) and median survival time (21 months) in the Survivin (-) group were significantly higher than those in the Survivin (+) group (22.0%, 9 months) , The difference was statistically significant, χ ~ 2 = 29.893, P <0.001. The 1-year cumulative survival rate (90.0%) and median survival time (18 months) in the uPA (-) group were significantly higher than those in the uPA (+) group (5.9%, 9 months) ~ 2 = 41.495, P <0.001. The Survivin (-) / uPA (-) group had higher postoperative survival than the other groups, with a significant difference (χ ~ 2 = 52.453, P <0.001). Cox multivariate analysis showed that lymph node metastasis (P = 0.018), Survivin (P <0.001) and uPA overexpression (P <0.001) were independent prognostic factors for pancreatic cancer. Conclusion There is a synergistic relationship between Survivin and uPA protein in the process of invasion and metastasis of pancreatic cancer. The combined detection of them may reflect the prognosis of pancreatic cancer more accurately and complement the prognosis of pancreatic cancer as lymph node metastasis.