1、分子诊断与治疗杂志2023年7月第15卷第7期J Mol Diagn Ther,July 2023,Vol.15No.7论著基金项目：吴阶平医学基金会临床科研专项资助基金（320.6750.1908998）作者单位：首都医科大学附属北京友谊医院平谷医院放射科，北京 101200通信作者：宋丹丹，Email：CK20、P53、Ki67蛋白联合影像学特征与结肠癌分化程度及预后的关系宋丹丹王超李军王蕾摘要 目的探讨细胞角蛋白 20（CK20）、肿瘤抑制基因（p53）、细胞增殖核抗原 Ki67（Ki67）联合影像学特征与结肠癌分化程度及预后的关系。方法以 2017 年 1 月至 2021 年 6 月首
2、都医科大学附属北京友谊医院平谷医院收治的 125 例结肠癌患者为研究对象，均有保存切除的肿瘤组织，并按分化程度分为低分化组（n=41）、中分化组（n=51）、高分化组（n=33）。检测患者肿瘤组织中的 CK20、P53、Ki67 蛋白表达，CT 记录结肠癌患者的影像学特征，比较不同分化程度患者肿瘤组织中的 CK20、P53、Ki67 蛋白表达及影像学特征。所有患者随访 1 年，并按预后情况分为预后良好组（n=107）及预后不良组（n=18），比较不同预后患者的 CK20、P53、Ki67 蛋白表达及影像学特征，ROC 分析患者 CK20、P53、Ki67 蛋白对结肠癌患者不良预后的预测价值。结
3、果不同分化程度组的 CK20、P53、Ki67 蛋白表达比较，低分组的CK20、P53、Ki67 阳性蛋白表达均高于中、高分化组（c2=9.055，9.543，12.239，P0.05）；低分组的肠壁增厚程度、受累肠管长度、淋巴结数目及 CT 值均高于中、高分化组，差异有统计学意义（c2=7.571，6.493，F=24.101，22.491，6.373，P0.05）。多因素 Logistic 回归分析显示，CK20、P53、Ki67 阳性蛋白表达及影像学特征（肠壁增厚程度、受累肠管长度、淋巴结总数、最大淋巴结的短径及 CT 值）均是结肠癌患者预后的独立危险因素（P0.05）。ROC 曲线显示
4、，CK20、P53、Ki67 蛋白及三者联合检测曲线下面积为 0.731、0.821、0.854、0.931。结论结肠癌患者肿瘤组织中 CK20、P53、Ki67 蛋白及影像学特征与患者的分化程度和预后有关，CK20、P53、Ki67 蛋白联合检测对患者预后有较高的预测价值。关键词 细胞角蛋白 20；肿瘤抑制基因；细胞增殖核抗原 Ki67；影像学特征；结肠癌Relationship between the combined imaging features of CK20，P53 and Ki67 proteins andthe degree of differentiation and pr
5、ognosis of colon cancerSONG Dandan，WANG Chao，LI Jun，WANG Lei（Radiology Dept，Pinggu Hospital，Beijing Friendship Hospital，Capital Medical University，Beijing，China，101200）ABSTRACT ObjectiveTo investigate the relationship between cytokeratin 20（CK20），tumor suppressor gene（p53），and cell proliferation nuc
6、lear antigen Ki67（Ki67）combined with imaging features andthe degree of differentiation and prognosis of colon cancer.MethodsOne hundred and twentyfive colon cancer patients admitted to Beijing Friendship Hospital Pinggu Hospital of Capital Medical University from January 2017 to June 2021，all of who
7、m had preserved resected tumor tissues，were selected and divided into thelow differentiation group（n=41），the medium differentiation group（n=51），and the high differentiationgroup（n=33）according to the degree of differentiation.Western blot was used to detect the protein expressionof CK20，P53 and Ki67
8、 in patients tumor tissues，and CT was used to record the imaging characteristics of patients with colon cancer，and to compare the protein expression of CK20，P53 and Ki67 and imaging characteristics in tumor tissues of patients with different degrees of differentiation.All patients were followed up f
9、or 1 1234分子诊断与治疗杂志2023年7月第15卷第7期J Mol Diagn Ther,July 2023,Vol.15No.7year and divided into the good prognosis group（n=107）and the poor prognosis group（n=18）according totheir prognosis.CK20，P53，Ki67 protein expression and imaging characteristics of patients with differentprognosis were compared，and t
10、he predictive value of CK20，P53，Ki67 protein on poor prognosis of coloncancer patients was analyzed by the ROC.ResultsThe protein expression of CK20，P53 and Ki67 in the different differentiation degree groups were compared，and the positive protein expression of CK20，P53 andKi67 in the low subgroups
11、were higher than those in the middle and high differentiation groups（c2=9.055，9.543，12.239，P0.05）.The degree of intestinal wall thickening，length of involved intestinal canal，numberof lymph nodes and CT values were higher in the low group than those in the medium and high differentiationgroups，and t
12、he difference was statistically significant（c2=7.571，6.493，F=24.101，22.491，6.373，P0.05）.Multifactor logistic regression analysis showed that CK20，P53，Ki67 positive protein expression and imagingfeatures（degree of intestinal wall thickening，length of involved intestinal canal，total number of lymphnod
13、es，short diameter of the largest lymph node and CT value）were independent risk factors for the prognosisof patients with colon cancer（P0.05）.The ROC curves showed that the areas under the curves of CK20，P53，Ki67 protein and the combined detection of the three were 0.731，0.821，0.854，0.931.ConclusionT
14、heCK20，P53，Ki67 proteins and imaging features in tumor tissues of colon cancer patients are related to the differentiation degree and prognosis of patients，and the combined detection of CK20，P53 and Ki67 proteins hasa high predictive value for patients prognosis.KEY WORDS Cyotkeratin20；Tumor suppres
15、sor genes；Nuclear associated antigen；Imaging Features；Colon Cancer结肠癌是最常见的消化道恶性肿瘤，其在我国的发病率及死亡率位于世界前列1。结肠癌分化程度与患者预后、疗效等密切相关，故早期评估肿瘤组织的分化程度具有重要意义。CT 可较好的诊断结肠癌患者，但对于影像学特征不典型者，仍需借助其他生物指标进行鉴别。细胞角蛋白 20（cyotkeratin20，CK20）与肿瘤的转移、疗效及预后等存在一定的相关性；P53 为肿瘤抑制基因，其突变与缺失是诱发多种肿瘤发生的主要因素；细胞增殖核抗原 Ki67（nuclear associate
16、d antigen，Ki67）是细胞核增殖指数的特异性指标，能准确反映细胞增殖水平2。因此，本研究探讨 CK20、P53、Ki67 蛋白联合影像学特征与结肠癌分化程度及预后的关系，现报道如下。1资料与方法1.1一般资料选取 2017 年 1 月至 2021 年 6 月首都医科大学附属北京友谊医院平谷医院收治的 125 例结肠癌 患者，其中男性 62 例，女性 63 例，平均年龄（66.4211.25）岁。纳入标准：均经结肠镜或病理检查确诊为结肠癌3；均接受 CT 检查；首次确诊者；临床资料完整者。排除标准：合并其他恶性肿瘤者；有接受放化疗者；合并肝肾不全者；存在精神疾史者；生存期75%（4 分）。最终评分为两项评分之积，9 cm淋巴结总数（个）最大淋巴结的短径（mm）CT 值低分化组（n=41）30（73.2）31（75.6）29（20.7）5（12.2）36（87.8）7（17.1）34（82.9）6.221.060.790.2239.158.74中分化组（n=51）26（51.0）a24（47.1）a21（41.2）a18（35.3）33（64.7）a19（37.3）32（62.8
