BCL-2的表現在評估鼻咽癌患者預後的價值

Prognostic value of bcl-2 expression in patients with nasopharyngeal carcinomas

賴瑞忠(JUI-CHUNG LAI)

指導教授 ： 陳穆寬

長榮大學/健康科學學院/醫學研究所/碩士(2007年)

https://doi.org/10.6833/CJCU.2007.00137

摘要

Bcl-2蛋白可以藉由阻斷細胞凋亡（apoptosis）來表現其致癌基因的效應。在某些惡性腫瘤，Bcl-2的表現可能導致疾病的惡化，而且在臨床上有較差的預後，但在另外一些惡性腫瘤反而有較好的預後。本研究的目的在於探討Bcl-2的表現對於評估鼻咽癌的患者預後的意義。因此，我們設計了一個探討治療結果與Bcl-2表現的研究。

在五年間，共有一百四十五個新診斷鼻咽癌的患者納入研究中，並以免疫組織化學染色法（immunohistochemical staining）來評估其細胞中Bcl-2表現的程度，之後分析Bcl-2的表現與臨床上預後兩者之間的關聯性。

在一百四十五個患者中，Bcl-2表現呈陽性的有四十七個，佔百分之三十二點四。其中Bcl-2的表現明顯與淋巴結的轉移與否有關（P值為0.006）。Bcl-2表現陽性的患者與Bcl-2表現陰性的患者相比，其五年存活率明顯較差並有統計學上的差異（P值為0.027）。雖然在早期（early-staged）的鼻咽癌患者中， Bcl-2的表現與否並非影響預後的因子（P值為0.504）。但相對地，在較晚期（advanced-staged）的鼻咽癌患者中，Bcl-2表現陽性的患者都有較差的預後且有統計學上的意義（P值為0.020）。

綜合上述，結果顯示在Bcl-2表現陽性的鼻咽癌患者，有較嚴重的淋巴結轉移，並且有較差的預後。因此Bcl-2的表現確實可以在鼻咽癌患者中，當作預後評估的因子（prognostic marker）。尤其在晚期的鼻咽癌患者中，若其呈現Bcl-2表現為陽性時，其治療預後明顯預期會較差，因此對這些患者應給予更積極的治療。

關鍵字

鼻咽癌 ； 癌症分期 ； 存活率 ； 預後標記

並列摘要

Objective: To explore the potential prognostic significance of Bcl-2 protein in patients with nasopharyngeal carcinoma (NPC).

Design: An investigation of the treatment outcome and Bcl-2 expression at a tertiary referral center.

Subjects: One hundred and fifty five patients with newly diagnosed NPC were included in this study over a 5-year period. The Bcl-2 expression was assessed by immunohistochemical stain. The correlation between Bcl-2 expression and clinical outcomes was analyzed (adjusted for chemotherapy).

Results: Among the 145 patients, 47(32.4%) of them were Bcl-2 positive. The expression of Bcl-2 significantly correlated with the presence of lymph nodes (p=0.006). Patients with Bcl-2 positive tumors had a worse disease-free cumulative 5-year survival than those with Bcl-2 negative tumors, and the difference was statistically significant (p=0.027). In early-staged NPC, Bcl-2 expression was not a prognostic factor (p=0.504). In contrast, in advance-staged NPC, Bcl-2 expression revealed a poor predictor and the difference was statistically significant (p=0.020).

Conclusions: NPC patients with positive Bcl-2 expression had advanced lymph node metastasis and a poorer prognosis. Therefore, Bcl-2 expression is a potential prognostic biomarker in patients with NPC. In advanced cases with Bcl-2 expression, the prognosis is poor and more aggressive treatment could be considered.

並列關鍵字

nasopharyngeal carcinoma ； Bcl-2 ； cancer stage ； survival ； prognostic biomarker.

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