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S100P在结直肠癌中异常表达的临床意义及其调控机制
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摘要
研究背景
     结直肠癌是世界范围内常见的恶性肿瘤,在我国结直肠癌居癌症致死因素的第四位。尽管近年来手术方式和辅助治疗手段不断发展,结直肠癌患者的生存率仍旧不理想。深入研究结直肠癌的分子机制,寻找理想的用于早期诊断或判断预后的结直肠癌肿瘤标志物,具有重要的临床意义。近年来关于S100P在肿瘤组织中的异常表达逐渐受到重视,其在多种肿瘤中均有异常表达,且与肿瘤的生长、浸润及转移密切相关,对部分肿瘤的诊断分型及预后判断均有一定价值。但是,S100P在结直肠癌中高表达的临床价值尚未明确。
     研究目的
     明确S100P在结直肠癌组织中高表达的临床意义,探讨调控S100P基因表达的表观遗传学机制。研究结直肠癌患者血清S100P水平是否增高及其临床价值。
     实验方法
     选取我院自2003年7月至2006年7月手术切除的96例散发性结直肠癌及配对正常结直肠组织标本与其中76例患者的术前血清标本。统计所有患者的临床病理资料,并进行为期30~65个月的术后随访。
     采用免疫印迹法和实时定量逆转录PCR的方法检测S100P蛋白和mRNA在结直肠癌组织与正常对照组织以及结直肠癌细胞系中的表达。并与患者的临床病理资料和预后相关资料进行统计分析。
     通过对基因组经亚硫酸氢盐修饰后直接测序的方法明确S100P基因启动子区甲基化与基因表达的相关性。建立荧光实时定量甲基化特异性PCR的方法检测结直肠癌组织与正常对照组织以及结直肠癌细胞系中S100P基因启动子区甲基化状态,并与S100P基因的表达和患者临床资料进行相关分析。
     通过ELISA方法检测结直肠癌患者及健康正常人血清S100P水平,并结合患者临床病理资料与预后相关资料评价结直肠癌患者术前血清S100P测定的诊断价值和预后价值。
     实验结果
     96例散发性结直肠癌患者中男性61例,女性35例,平均年龄62.4±1.2岁;右半结肠癌29例,左半结肠癌17例,直肠癌50例。S100P蛋白在结直肠癌组织中表达的阳性率为63.0%(51/81),显著高于正常对照组织(4.9%,P=8.13×10_(-15));S100P mRNA在结直肠癌组织中的表达也显著高于配对的正常对照组织(P=0.005)。通过对基因组经亚硫酸氢盐修饰后直接测序的方法检测S100P基因启动子区甲基化状态在结直肠癌肿瘤细胞系和组织中与S100P mRNA的表达显著相关(P值分别为0.002;0.039)。通过荧光实时定量甲基化特异性PCR的方法检测S100P基因启动子区甲基化状态在结直肠癌肿瘤细胞系和组织中与S100P mRNA的表达也有显著的相关性(P值分别为0.001;5.0×10~(-6))。
     结直肠癌组织中S100P蛋白的表达与肿瘤的原发部位显著相关(P=0.008),从右半结肠、左半结肠至直肠,S100P蛋白的阳性率分别为42.3%、61.5%、76.2%。S100P蛋白的表达与结直肠的临床分期无显著性相关(P=0.524)。S100P mRNA在结直肠癌中的表达与肿瘤的原发部位、临床分期等临床特征并无显著的相关性。S100P基因启动子区去甲基化状态的定量值在直肠癌显著高于结肠癌(P=0.007),且其随着结直肠癌分化程度的减低有逐渐减低的趋势(P=0.098)。在Ⅰ~Ⅲ期的结直肠癌患者中,组织S100P阴性患者的预后有优于组织S100P阳性患者的趋势(P=0.056)。
     结直肠癌患者术前血清S100P水平显著高于正常人(P=7.4x10~(-9))。血清S100P诊断结直肠癌的敏感度为38.2%,相对于正常人的特异度为91.9%,联合血清CEA检测在结直肠癌患者中的阳性率可达64.4%。结直肠癌患者血清S100P水平有随肿瘤分期逐渐升高的趋势(P=0.050),其阳性率分别为Ⅰ期25.0%、Ⅱ期30.8%、Ⅲ期44.4%、Ⅳ期54.5%。术前血清S100P水平是结直肠癌患者长期生存的独立影响因素(P=0.023)。术前血清S100P阳性的结直肠癌患者的5年生存率为52.3%,而术前血清S100P阴性患者的5年生存率为81.4%(P=0.005)。在调整了临床分期的影响后,术前血清S100P升高的结直肠癌患者死亡的风险是血清S100P正常者的3.6倍。
     实验结论
     S100P蛋白与mRNA在结直肠癌组织中的表达显著高于配对的正常结直肠组织,S100P蛋白的表达与肿瘤的原发部位显著相关,并与患者的生存时间呈负相关趋势。S100P基因启动子区的甲基化状态与基因表达密切相关,可能在一定程度上参与调控了S100P基因的表达。结直肠癌患者术前血清S100P水平显著高于健康正常人群,并与生存时间显著相关,其水平升高提示患者预后不良。与血清CEA联合检测可提高诊断结直肠癌的敏感性。
Background:Colorectal cancer(CRC) is one of the most common types of malignant tumors worldwide.In China,CRC is the 4th leading cause of cancer-related mortality.Although great advances have been made in the diagnosis and treatment of this cancer,the survival rate of CRC patients is not improved profoundly.It has important clinical significance to put insights into the molecular mechanism of CRC and to search for the ideal markers for the early diagnosis and prognosis.In recent years,researchers has paid close attention to S100P,which has abnormal expression in many tumors and may contribute to the growth、infiltration and metastasis of tumor cells.The expression of S100P is related to the diagnosis or prognosis in some tumors.It has not been identified,however,the clinical value of the high expression of SIOOP in CRC.
     Objective:To identify the clinical significance of S100P high expression in CRC tissue,and to investigate Epigenetic mechanisms of S100P expression. Moreover,the serum level of S100P in CRC and its clinical value is to be studied.
     Methods:The postoperative tumor tissue samples and their paired normal colorectal tissue from 96 patients and preoperative serum specimens from 76 patients with sporadic CRC in our hospital were collected from July 2003 to July 2006.The clinical pathologic data of these patients were integrated,with the follow-up period of 30 to 65 months.
     Western blot and real-time quantitative reverse-transcription PCR were performed for detecting the expression of S100P protein and mRNA in CRC tissue and in colorectal cancer cell lines.The data of the expression of S100P protein and mRNA were analyzed and correlated with the clinical pathologic information.
     The correlation of S100P promoter region methylation and S100P gene expression was identified by Bisulphite Sequencing PCR(BSP).The method of fluorescence real time Quantitative Methylation Specific PCR(QMSP) was set up to detect the methylation state of S100P promoter region in CRC tissue and in colorectal cancer cell lines.The date from BSP and QMSP were then correlated with the S100P gene expression and clinical data.
     Enzyme linked immunosorbent assay(ELISA) was used for detecting the serum level of S100P in patients with CRC and normal controls.The results were correlated with the clinical data to evaluate the diagnosis and prognosis value of the preoperative serum S100P level in patients with CRC.
     Results:Of 96 patients with sporadic CRC involved in this study,61 were males and 35 were females,including 29 right hemicolon cancers,17 left hemicolon cancers and 50 rectal cancers.The average age was 62.4±1.2 years.63.0%(51/81) of CRC tissue express S100P protein,significantly higher than the paired control group(4.9%,P=8.13×10~(-15)).The expression of S100P mRNA in CRC tissue is also significantly higher than the paired normal group(P=0.005).The methylation state of S100P promoter region detected by BSP was strikingly correlated with the expression of S100P mRNA(P=0.002, 0.039,respectively) in colorectal cancer cell lines and tissue.A similar result was obtained through fluorescence real time QMSP in colorectal cancer cell lines and tissue(P=0.001,5.0×10~(-6),respectively).
     The expression of S100P protein in CRC tissue has significant correlation with the primary cancer location.The expressing rate of S100P protein in CRC was 42.3%for right hemicolon,61.5%for left hemicolon,and 76.2%for rectum. The similar relation was not shown between the expression of S100P protein and the clinical stage.However there was no notable correlation between the expression of S100P mRNA and the clinical features of CRC such as primary cancer location and clinical stage.The quantitation of the methylation state of S100P promoter region was significantly higher in rectal cancer than in colon cancer(P=0.007),which also had a gradual downward trend according to the decrease of the tumor differentiation degree(P=0.098).In the CRC patients from stageⅠto stageⅢ,a tendency was shown that the prognosis of patients with S100P protein expression was better than that without expression(P= 0.056).
     The preoperative serum level of S100P in CRC patients is significantly higher than normal controls.The sensitivity of serum S100P level for diagnosis of CRC was 38.2%and the specificity was 91.9%compared with the healthy people.Combined test of serum S100P and CEA in CRC had a positive rate up to 64.4%.The preoperative serum S100P level in CRC patients had a tendency to increase as the cancer clinical stage progressing(P=0.050).The positive rate of serum S100P in each stage of CRC was stageⅠ25.0%,stageⅡ30.8%,stageⅢ44.4%and stageⅣ54.5%.The preoperative serum level of S100P was an independent factor of long - term survival(P=0.023) in CRC patients.The 5-year cumulative survival rate of patients with a high preoperative serum S100P level was 52.3%,and the 5-year cumulative survival rate of patients with a normal serum S100P level was 81.4%(P=0.005). If adjusted the influence of clinical stage,the CRC patients with elevated preoperative serum S100P had a 3.6 times increase in the risk of death comparing with those with normal serum S100P levels.
     Conclusions:The expression of S100P protein and mRNA in CRC tissue is significantly higher than the paired normal colorectal tissue.The expression of S100P protein is notably correlated with the primary cancer locations,and also has a negative correlation with survival of CRC patients.In some degree,the methylation state of S100P promoter region may regulate the expression of S100P.The preoperative serum S100P level in CRC patients is significantly higher than that in normal controls.Preoperative elevated serum S100P level correlates with a poor prognosis in CRC patients.Combined test of serum S100P and CEA can increase the sensitivity of diagnosis in CRC.
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