Necdin基因在人骨肉瘤中的表达及其临床意义△

Expression of Necdin gene in human osteosarcoma and its clinical significance

摘要:

［目的］观察 Necdin（NDN）基因在骨肉瘤中的表达，探讨其与骨肉瘤患者临床病理因素及预后的关系。［方法］回顾性研究 2009 年 10 月—2019 年 7 月手术治疗的 51 例骨肉瘤患者的临床资料，活检术确认后行新辅助化疗，瘤段切除与假体重建术。评价临床效果和组织 NDN 的表达。［结果］ 本组 51 例患者均得到随访 38 个月以上，术后生存时间最长为 78 个月， 最短者为 16 个月。随访过程中，局部复发 16 例，转移 33 例。末次随访时无瘤生存 10 例，带瘤生存 5 例，死亡 36 例。按末次随访结局分组比较。死亡组中 IIB、III 期所占比例明显高于无瘤生存组和带瘤生存组（P<0.05），死亡组中术前肺转移率明显高于生存组和带瘤生存组 （P<0.05）。而三组间年龄、性别、肿瘤大小和 NDN 检测结果的差异均无统计学意义 （P>0.05）。组织 NDN 免疫组化染色阳性率骨肉瘤组织为 29.41% （15/51），而瘤旁正常骨组为 80.00% （8/10），差异有统计学意义 （P< 0.05）。Kaplan-Meier 生存期及对数等级比较表明，不同 Ennecking 分期、是否肺转移、不同肿瘤大小、是否 NDN 阳性的患者平均生存时间的差异均有统计学意义（P<0.05）。Cox 分析表明，Ennecking 分期（HR=1.530）、肺转移（HR=4.662）、肿瘤大小 （HR=3.398） 是生存的危险因素，而 NDN 阳性 （HR=0.207） 是生存的保护性因素。［结论］ 瘤组织中 NDN 阳性表达显著低于瘤旁正常骨组织。术前 Ennecking 分期高、肺转移、肿瘤≥5 cm 是骨肉瘤不良预后的危险因素，NDN 阳性表达是保护因素。

Abstract:

[Objective] To observe the expression of Necdin (NDN) gene in osteosarcoma, and to explore its relationship with clinico- pathological factors and prognosis of osteosarcoma. [Methods] A retrospective study was performed on 51 patients who received neoadju- vant chemotherapy, as well as tumor segment resection and prosthetic reconstruction after osteosarcoma was confirmed by biopsy in our hos- pital from October 2009 to July 2019. The clinical outcomes, NDN expression in tissue were evaluated. [Results] All the 51 patients were followed up for more than 38 months, with survival time of 78 months in the longest and 16 months in the shortest. During the follow-up, 16 patients got local recurrence and 33 patients had metastasis. At the latest follow-up, 10 patients were of survival with tumor-free (STF) , 5 patients of survival with tumor (ST) , and 36 patients died (death) . In term of grouping comparison based on the outcome at the latest followup, the proportion of stage IIB and stage III in the death group was significantly higher than that in the tumor-free survival group and the tu- mor-bearing survival group (P＜0.05) , and the death group had significantly higher ratio of lung metastasis than the STF and ST groups (P＜ 0.05) . However, there were no significant differences in terms of age, gender, tumor size and NDN expression among the three groups (P＞ 0.05) . The positive rate of NDN immunohistological staining was of 29.41% (15/51) in osteosarcoma tissues, whereas 80% (8/10) in normal bone tissues around the tumor, which was statistically significant (P＜0.05) . As results of Kaplan-Meier survival analysis and log-rank test, the mean survival time proved significantly different in terms of different Ennecking stage, lung metastasis, tumor size and NDN (P＜0.05) . With regarding to Cox analysis, the Ennecking stage (HR=1.530) , lung metastasis (HR=4.662) and tumor size (HR=3.398) were risk factors for survival, while positive NDN (HR=0.207) were protective factors for survival. [Conclusion] The osteosarcoma tissue has significantly lower positive NDN expression than the adjacent normal bone tissue. The worsened preoperative Ennecking stage, lung metastasis and tu-mor ≥5 cm are risk factors for poor prognosis of osteosarcoma, while positive NDN expression is a protective factor.