摘要目的 探讨消化道肿瘤淋巴结转移灶多药耐药相关因子P-糖蛋白(P-gp)、谷胱甘肽S转移酶-π(GST-π)、p53、survivin、bcl-2的表达特点及临床意义.方法 对54例胃癌和大肠癌的转移淋巴结、原发灶中上述5种多药耐药相关因子行免疫组织化学染色,对比其表达的差异.结果 转移灶与原发灶相比,P-gp、GST-π在二者间表达的差异具有统计学意义(P均<0.05);p53、bcl-2表达在二者之间具有明显相关性(r=0.7248、0.5524;P均<0.05).在转移淋巴结,P-gP分别与GST-π及survivin表达呈正相关(r=0.4062、0.6169,P均<0.05),GST-π与survivin表达呈正相关(r=0.4027,P<0.05);而在原发灶,bel-2与P-gP及survivin表达呈正相关(r=0.3986、0.2937,P均<0.05)、GST-π与survivin表达呈正相关(r=0.4481,P<0.01),仅GST-π与survivin正相关表达同时出现在转移灶和原发灶内.结论 消化道肿瘤淋巴结转移灶存在多药耐药相关因子表达的异质性,肿瘤切除术后辅助化疗的靶目标应针对淋巴结转移灶.

abstractsObjective To investigate the expression features of P-glycoprotein (P-gp), glutathione S transferase-π (GST-π) and inhibitor of apoptosis proteins like p53, survivin and bcl-2 in lymph node metastases of gastrointestinal carcinomas. Methods The expression of P-gp, GST-π, p53, survivin and bcl-2 were determined by using immunohistochemistrical technique in surgical specimens of primary tumor (PT) and lymph node metastases (LNMs) from 54 gastrointestinal cancer patients with metastatsis of lymph nodes. The expression difference of 5 multidrugs resistance (MDR)-related factors between LNMs and PT were compared. Results Significant difference was found in the expression of P-gp and GST-π between the two groups (both P<0.05), and expression of p53 and bcl-2 showed positive correlation between LNMs and PT (r=0.7248, 0.5524; both P<0.05), respectively. In LNMs, P-gp expression was positively correlated with GST-π (r=0.4062, P<0.05) and survivin (r=0.6169, P<0.05), and also GST-π expression was related positively with survivin (r=0.4027, P<0.05). Statistically positive correlations were noted between bcl-2 and P-gp (r=0.3986, P<0.05), bcl-2 and survivin (r=0.2937, P<0.05), as well as GST-π and survivin (r=0.4481, P<0.01) in PT. Only a positive correlation between GST-π and survivin expression was simultaneously shown in both LNMs and PT. Conclusions There is significant heterogeneity of MDR-related factors expression in LNMs of gastrointestinal carcinomas. Effective adjuvant chemotherapy after operation should target on the metastatic loci of the disease.