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研究生:賴瑞忠
研究生(外文):Jui-Chung Lai
論文名稱:BCL-2的表現在評估鼻咽癌患者預後的價值
論文名稱(外文):Prognostic value of bcl-2 expression in patients with nasopharyngeal carcinomas
指導教授:陳穆寬陳穆寬引用關係
指導教授(外文):Mu-Kuan Chen
學位類別:碩士
校院名稱:長榮大學
系所名稱:醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:中文
論文頁數:74
中文關鍵詞:鼻咽癌癌症分期存活率預後標記
外文關鍵詞:nasopharyngeal carcinomaBcl-2cancer stagesurvivalprognostic biomarker.
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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。
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.
論文口試委員審定書 1
博碩士論文授權書 2
目錄 3
第一章 中文摘要 4
第二章 緒論 6
第一節 鼻咽癌概論
第二節 鼻咽癌之致病機轉與治療
第三節 BCL-2與細胞凋亡﹙apoptosis﹚
第四節 研究動機與目的
第三章 材料與方法 19
第一節 病人收案標準與檢體收集
第二節 實驗材料與方法
第三節 統計方法
第四章 實驗結果 24
第一節 病人特徵與預後
第二節 免疫組織化學染色結果
第三節 BCL-2的表現與性別、年齡、腫瘤大小、
頸部淋巴結轉移
第四節 BCL-2的表現與臨床分期以及存活率
第五章 討論 26
第一節 BCL-2與各種腫瘤的關係
第二節 BCL-2與鼻咽癌的關係
第六章 結論及展望 29
第一節 結論
第二節 展望
第七章 英文摘要 30
第八章 參考文獻 32
第九章 圖表 41
第十章 附錄 52

附錄 51
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