检测p53和nm23基因表达对大肠肿瘤的临床诊断及预后判断的意义

目的 通过检测大肠肿瘤中p53和nm23基因表达，探讨其在大肠肿瘤临床诊断及预后判断中的意义。方法 回顾性分析95例大肠癌及57例大肠腺瘤患者的临床病理资料，对石蜡标本采用免疫组化SP法分别检测p53和nm23基因表达，分析其免疫组化特点与临床病理之间的关系。结果 p53基因在大肠癌中高表达，而在大肠腺瘤中低表达；腺瘤伴低或中级别上皮内瘤变组p53的表达阳性率25．93％（7／27）与腺瘤伴高级别上皮内瘤变组65．22％（15／23）之间比较，差异有统计学意义（t=5．56，P〈0．05）；腺癌伴转移组nm23表达阳性率31．25％（5／16）与腺癌无转移组（包括腺瘤体高级男性皮内瘤变和腺癌组）比较，差异有统计学意义（t=3．62，P〈0．05）；nm23的阳性表达率在DukeC期为70．00％（15／20），与A、B期之间比较，差异有统计学意义（t=2．79，P〈0、05）。结论 p53和nm23基因表达可能影响大肠癌发生发展，联合检测p53和nm23基因表达对大肠癌临床分级、分期有辅助意义；p53检测有助于大肠肿瘤早期诊断；nm23可作为预后判断的重要指标之一。

The significance of p53 and nm23 gene expressions in clinical diagnosis and prognosis prediction of large intestine tumors

Objective To study the significance of p53 and nm23 gene expressions in clinical diagnosis and prognosis prediction of large intestine tumors. Methods The clinical and pathological data of 95 colorectal cancer and 57 colorectal adenoma cases were analyzed retrospectively. P53 and nm23 gene expressions were checked by SP method of immunohistochemistry in paraffin specimens. Then the immunohistochemical characteristics of the tumor and their relationship to clinical pathology were analyzed. Results P53 gene had high expression in large intestine cancer but low in large intestine adenoma. There was obvious difference of p53 expression positive rates between adenoma with low or medium level epithelial dysplasia group 25.93 % （7/27） and adenoma with high level epithelial dysplasia group 65.22 % （ 15/23 ） （ t = 5.56 , P 〈 0.01） ; the nm23 expression positive rate in adenocarcinoma with metastasis group was 31.25 % （5/ 16） , which had obvious difference with non metastosis group（t = 3.62, P 〈 0.05） ; there was obvious difference（ t = 2.79,P 〈 0.05） of nm23 positive rate among Dukes stage C and A, B . Conclusions p53 and nm23 gene expressions might influence carcinogenesis and tumor development of large intestine cancer. There is assistant value in clinical scaling and staging of large intestine cancer by combining examination of both p53 and nm23 gene expressions. P53 examination is helpful in early diagnosis of colorectal tumor, while nm23 can be one of the important indexes for prognosis prediction.