T-cadherin蛋白在急性早幼粒细胞白血病中表达及其临床意义

Expression and clinical significance of T-cadherin in acute promyelocytic leukemia

摘要:

目的：探讨T-钙黏蛋白（T-cadherin）在急性早幼粒细胞白血病（acute promyelocytic leukemia，APL）患者中的表达情况及临床意义。方法：采用免疫组化法检测并分析60例APL患者和同期检查健康者60例骨髓活检组织中T-cadherin蛋白的表达情况，并分析T-cadherin蛋白的表达水平与APL患者临床病理特征、临床疗效和生存预后的关系。结果：T-cadherin蛋白在APL患者中低表达率和高表达率分别是71.7%和28.3%；在正常人骨髓活检组织中的低表达率和高表达率分别是25.0%和75.0%，2组间进行比较具有统计学差异（?字2=26.162，P=0.000）。APL患者骨髓活检组织中T-cadherin蛋白的表达与患者危险度分级、早幼粒细胞比例和患者复发有关（均P<0.05），与患者年龄、性别、白细胞计数、血红蛋白计数和血小板计数数目无关（均P>0.05）。采用Cox回归模型分析显示，危险度分级、早幼粒细胞比例和T-cadherin蛋白低表达是APL患者复发的独立危险因素（均P<0.05）。T-cadherin蛋白低表达组的缓解率和总有效率分别是62.8%和69.8%，T-cadherin蛋白高表达组的缓解率和总有效率分别为88.2%和94.1%，两组比较无统计学差异（均P>0.05）。经过Log-rank检验显示APL患者T-cadherin蛋白低表达和T-cadherin蛋白高表达的5年生存率分别是53.5%和82.4%（?字2=4.294，P=0.035）。Kaplan-Meier生存分析显示T-cadherin蛋白低表达5年生存率明显低于T-cadherin蛋白高表达组（P=0.045）。结论：T-cadherin蛋白在APL患者中呈明显低表达，并与患者危险度分级、早幼粒细胞比例和患者复发有关，可能是生存预后的重要判断因子。

Abstract:

Objective：To investigate the expression and clinical significance of T-cadherin in patients with acute promyelocytic leukemia（APL）. Methods：A total of 60 patients with APL and 60 healthy subjects who underwent physical examination were en－rolled，and immunohistochemistry was used to measure the expression of T-cadherin in bone marrow biopsy samples. The association of the expression of T-cadherin with clinicopathological features, clinical outcomes, and survival/prognosis was analyzed. Results：The low and high expression rates of T-cadherin were 71.7% and 28.3% in APL patients and 25.0% and 75.0% in healthy subjects，and there was a significant difference between the two groups（?字2=26.162，P=0.000）. In APL patients，the expression of T-cadherin in bone marrow biopsy samples was associated with risk classification，percentage of promyelocytes，and recurrence（all P<0.05） and was not associated with age，sex，white blood cell count，hemoglobin，and platelet count（all P>0.05）. The multivariate Cox regression analysis showed that risk classification，percentage of promyelocytes，and low expression of T-cadherin were independent factors for recurrence in patients with APL（all P <0.05）. The low-T-cadherin expression group had a remission rate of 62.8% and an overall response rate of 69.8%，and the high-T-cadherin expression group had a remission rate of 88.2% and an overall response rate of 94.1%；there was no significant difference between the two groups（both P>0.05）. The log-rank test revealed that the five-year survival rate was 53.5% in APL patients with low expression of T-cadherin and 82.4% in those with high expression（?字2=4.294，P=0.035）. The Kaplan-Meier survival analysis showed that the patients with low expression of T-cadherin had a significantly lower 5-year survival rate than those with high expression（P=0.045）. Conclusion：There is low expression of T-cadherin in APL patients，which is associated with risk classification，percentage of promyelocytes，and recurrence. Therefore，T-cadherin may be an important predictor for survival/prognosis.