分化型甲状腺癌组织中β-连环蛋白和维生素D受体的表达及其与术后复发关系的探讨

Expressions of β-catenin and VDR in differentiated thyroid carcinoma and their relationships with postoperative recurrence

摘要:

目的 探讨分化型甲状腺癌组织中β-连环蛋白（β-catenin）和维生素D受体（VDR）表达，并分析其与术后复发的关系。方法 回顾性分析2009年7月-2015年7月收治的185例分化型甲状腺癌患者的临床资料，均接受手术切除治疗，其中甲状腺全切/次全切术101例，术中实施颈淋巴结清扫术者82例；腺叶加峡叶切除术80例，术中实施颈淋巴结清扫术者65例；局部广泛切除术4例，均于术中实施颈淋巴结清扫术。采用免疫组化法（SP）检测癌组织和切缘正常组织β-catenin、VDR表达，对比其阳性表达率；对比复发与未复发患者癌组织β-catenin、VDR阳性表达率；分析影响患者术后复发的危险因素。结果 癌组织β-catenin、VDR蛋白阳性表达率分别为75.68%、35.68%，切缘正常组织分别为62.70%、67.03%，差异均具有统计学意义（P<0.05）；术后随访1~10.5年，平均（4.52±1.01）年，复发率为10.81%，复发患者癌组织β-catenin蛋白阳性表达率高于未复发患者（P<0.05），VDR蛋白阳性表达率低于未复发患者（P<0.05）；III期、腺叶加峡叶切除术、癌组织β-catenin蛋白阳性表达、癌组织VDR蛋白阴性表达均是分化型甲状腺癌患者术后复发的独立危险因素（P<0.05），而术中实施颈淋巴结清扫术、术后辅助治疗均是其保护因素。结论 分化型甲状腺癌组织中β-catenin蛋白阳性表达率较切缘正常组织高，VDR蛋白阳性表达率则较低，且复发患者更甚，癌组织β-catenin蛋白阳性表达、VDR蛋白阴性表达与III期、腺叶加峡叶切除术均是其危险因素，且术中实施颈淋巴结清扫术、术后辅助治疗可降低复发风险。

关键词:分化型甲状腺癌;β-连环蛋白;维生素D受体;复发

Abstract:

Objective To investigate the expressions of β-catenin and vitamin D receptor (VDR) in differentiated thyroid carcinoma, and to analyze their relationships with postoperative recurrence.Methods Clinical data of 185 patients with differentiated thyroid carcinoma surgically treated from July 2009 to July 2015 were analyzed retrospectively. All patients received surgical treatment including total/subtotal thyroidectomy in 101 cases with cervical lymph node dissection in 82, glandular lobectomy plus isthmus lobectomy in 80 cases with cervical lymph node dissection in 65, and local extensive thyroidectomy with cervical lymph node dissection in 4. Immunohistochemistry (SP) was used to detect the expressions of β-catenin and VDR in cancer tissues and normal tissues. The positive expression rates of β-catenin and VDR were compared between patients with and without recurrence. The risk factors of postoperative recurrence were analyzed.Results The positive expression rates of β-catenin and VDR protein were 75.68% and 35.68% in cancer tissues, and 62.70% and 67.03% in normal tissues, respectively, with statistically significant differences (P<0.05). The mean follow-up time was (4.52±1.01) years (range 1-10.5 years), and the recurrence rate was 10.81%. The positive expression rate of β-catenin protein in recurrent patients was higher than that in nonrecurrent patients (P<0.05), and the positive expression rate of VDR protein in recurrent patients was lower than that of nonrecurrent patients (P<0.05). Clinical stage III, adenoidectomy plus isthmus lobectomy, positive expression of β-catenin protein and negative expression of VDR protein were independent risk factors for postoperative recurrence of differentiated thyroid cancer (all P<0.05), while cervical lymph node dissection and postoperative adjuvant therapy were protective factors (both P<0.05).Conclusions In differentiated thyroid carcinoma, the positive expression rate of β-catenin protein is higher and that of VDR protein is lower than those in normal tissue, which is more distinct in the recurrent patients. The positive expression of β-catenin protein and negative expression of VDR protein and clinical stage III, adenoidectomy plus isthmus lobectomy are risk factors in differentiated thyroid carcinoma. Cervical lymph node dissection and postoperative adjuvant therapy may reduce the risk of recurrence.

Key words:Differentiated thyroid carcinoma;β-catenin;Vitamin D receptor;Recurrence