| Nephroblastoma, also known as Wilms'Tumor, is common in children with renal embryonal mixed tumor. WT is the second most common intra-abdominal cancer of children. It represents approximately 6% of all pediatric cancers and accounts for more than 95% of all tumors of the kidney in the pediatric. Affecting 1 in 10,000 children, usually before the age of 5 years.WT grew rapidly, with high degree of malignancy, metastasis early, and often transfer to the lung, liver.With surgical resection, radiotherapy and chemotherapy combined, so that a substantial increase in survival of children, but easy to invasion and metastasis is still the treatment of difficult.On tumor metastasis suppressor gene and the identification analysis of related genes to further determine the clinical stage, the development of rational treatment programs, to improve patient life expectancy, survival rates and side effects caused by unreasonable treatment.P27kip1, was discovered as heat stable proteins in 1994 by Polyak, the current few reports between the relationship P27 gene and WT, mainly that it is with non-small cell lung cancer, colorectal cancer, breast cancer and other tumors. The occurrence, development and prognosis are closely related,it is expressed in WT of the nucleus, can inhibit CDK or CDK-cyclin complex activity, thereby inhibite the cells from G1 to S phase of the transformation, cell cycle arrest at G1 phase. P27kip1 protein low expression in WT was significantly related to differentiation, local recurrence, lymph node metastasis, tumor stage.In 1995, Dong and others cloned KAI1 gene from a human prostate cancer, the structure of a cell membrane glycoprotein by affecting the cell and between cells and extracellular matrix signal transduction, regulate the process of cell proliferation. The expression of KAI1 currently found a negative correlation with metastatic, KAI1 gene play inhibition roles during the transfer in a variety of tumor, its expression level decreased and the prognosis of some tumors have a certain relationship.KAI1 is a WT metastasis supperssor gene, it can be used as clinical treatment and predicted prognosis indicators.Currently, the clinical diagnosis of WT examination techniques include: X-ray, intravenous urography excretory imaging, spiral CT, Ultrasonography, MRI and so on. SCT with high density resolution, not only can determine the lesion location, shape, and can accurately measure the size and density of lesions, demonstrates the extent of the tumor capsule, infiltration and adjacent organs, vessel involvement and distant metastasis.While post-processing functions using multi-plane, multi-angle reconstruction, improve the diagnosis of WT, the accuracy of preoperative staging evaluation for surgical treatment of choice and to further define the program and improve the survival rate of children provided help.Analysis the correlation between the SCT signs of WT and tumor stage, P27Kipl, KAI1 gene expression, to further evaluation of disease invasion, tumor stage,and the relationship between molecular biology, thus the choice of clinical treatment and prognosis to provide more accurate, reliable guidance.Materials and methods Collected 30 cases of WT specimens and 10 cases of paraffin tumor tissue, between 2006.01-2010.08 confirmed by surgery and pathology from first and the third Affiliated Hospital of Zhengzhou University, all patients underwent preoperative dynamic contrast-enhanced SCT scan.Collected by the pathology of WT confirmed 30 cases of paraffin, the patients underwent preoperative SCT scan+enhanced scan.17 males and 13 females, aged 8 months -9 years old, an average of 3.5±0.78 years. SCT which signs and violations of adjacent structures, surgical pathology were 11 cases and 9 cases, SCT signs and pathologic diagnosis of lymph node metastasis were 7 cases and 9 cases,2 patients with lung metastases. Children with none preoperative chemotherapy and radiotherapy, the tissue samples were in 10% neutral buffer formalin immersion fixed, embedded in paraffin, serially sectioned to 4μm. Immunohistochemical sections were stained by two pathological physicians.Rely on intraoperative conditions and pathological diagnosis of WT United States Study Group (NWTS-5) standard to determine pathological stage, this study in group I(n=9), group II(n=8), groupⅢ(n=11), group IV(n=2). SCT based on the standard in groupⅠ(n=8), group II(n=11), group III(n=9), group IV(n=2) Immunohistochemistry (SP) detected 30 cases of WT paraffin P27kip1, KAI1 expression. Statistical analysis using SPSS 16.0 software processing to a=0.05 level for the test.Results1. SCT signs with or without lymph node metastasis, P27kip1 positive expression of 3 cases,17 cases, the difference between the two groups were statistically significant(P<0.05), KAI1 expression positive were 2 cases,7 cases, the difference between the two groups were statistically significant (P<0.05).2.30 cases of WT in stage I+II, SCT diagnosis 19 cases, P27kipl positive 16 cases; III+IV 11 cases, P27kipl expression 4 cases, the difference between the two groups were statistically significant (P<0.05), KAI1 positive expression were 12 cases,3 cases, no significant difference between the two groups (P> 0.05). 3. SCT signs have or no adjacent invision, P27 ip1 positive expression were 3 cases,15 cases, the difference was statistically significant (P<0.05), KAI1 positive expression were 2 cases,13 cases, there were significant differences between the two groups (P<0.05).4.30 cases of Wilms tumor P27kip1 expression 20 cases, KAI1 positive expression 15 cases; there were no significant difference between the two groups (P>0.05).Conclusion1. WT SCT signs and P27kip1, KAI1 expression can predict the invasion of WT metastasis.2. SCT signs adjacent structure invasion, lymph node metastasis and high stage in the SCT group stage P27kip1 decreased expression, P27kipl expression negatively correlated with metastasis.3. SCT signs on adjacent structures invasion and lymph node metastasis,SCT staging of high stage KAI1 decreased expression, KAI1 expression was negatively correlated with tumor metastasis. |
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