| Background and Objective: The prognosis of nasopharyngeal carcinoma (NPC) is related to many factors, the presence or absence of cervical lymph nodes have a great impact on the prognosis of nasopharyngeal carcinoma. To our knowledge, no joint analysis of cervical lymph nodes metastasis in correlation to vascular endothelial growth factor C(VEGF-C),Ki67 and nm23-H1 protein expression in NPC was performed. Therefore, the aim of this study was to assess the relationship between the expression of above the proteins in NPC with theirs clinical pathological characteristics and prognostic significance and their potential relevance of cervical lymph nodes metastasis.Methods: Archival formalin fixed, paraffin embedded specimens from 44 patients who had undergone surgery for NPC between August 2001 and December 2006 in Anhui provincial hospital were recuited in this study.There were 29 male and 15 female with a median age of 55 years(range 26~81 years).VEGF-C,Ki67 and nm23-H1 protein expression were detected in NPC tissues by streptavidin-peroxidase immunohistochemistry. Statistical anaysis was perormed using SPSS statistical software package(version13.0). Survival curves were calculated according to Kaplan-Meier method and compared with the use of log-rank test. Multivariate analysis was based on Cox regression model with P values lower than 0.05 considered as statistically significant. Results: VEGF-C, Ki67 and nm23-H1 protein expressed significantly in NPC, and the corresponding positive rates were 72.7%, 77.3% and 45.5%, respectively. The positive rates of VEGF-C, Ki67 and nm23-H1 were not related to T stage, clinical stage, Karnofsky performance status score(KPS) and anemia(P>0.05), while was significantly correlated with age, N stage, Complete Response of the primary treatment and 5-yeat survival(P<0.05). VEGF-C was positively correlated with Ki67 (r = 0.97, P = 0.000), and negative correlation with nm23-H1 (r =- 0.66, P = 0.016), there was no correlation between Ki67 and nm23-H1 (P = 0.074).The expression of VEGF-C and Ki67 in cervical lymph nodes metastasis group was significantly higher than that of the absence of cervical lymph nodes group (P <0.05), while nm23-H1 wsa on the contrary.Twenty-five patients died at the end of follow-up.The 3-year overall survival(OS)rate and the 5-year OS rate were 65.9% and 43.2%, respectively; and the median suvival time was 46.5 months (range 8～98months).The factors with inclusion of sex, age, KPS, T stage, N stage, clinical stage, Complete Response of the primary treatment ,VEGF-C, Ki67 and nm23-H1 were confirmed to be significantly associated with the survival time of paitents in univariate analysis with Kaplan-Meier mothod(P﹤0.05).The multivariate analysis with Cox hazard model demonstrated that N stage and Complete Response of the primary treatment and VEGF-C could be independent indicators for the prognosis of patients with NPC(P﹤0.05).Conclusions:1. The expression of VEGF-C and Ki67 in cervical lymph node metastasis group was higher than that the absense of cervical lymph node group and they were positively related. Maybe they were on the positive synergies for cervical lymph node metastasis.The two adverse factors decreased survival rates in long term.The Complete Response of the primary treatment of the patients with high Ki67 and nm23-H1 expression was significantly higher than that with low expression ,and VEGF-C was on the contrary,it can be show that the patients who had high expression of Ki67 and nm23-H1 and low expression of VEGF-C were more sensitive to radiotherapy .2. The expression of nm23-H1 in cervical lymph node metastasis group was lower than that patients without cervical lymph node metastasis, and the 5-year survival rate of high expression was significantly higher in patients with nm23-H1 low expression.3. N stage and Complete Response of the primary treatment and VEGF-C were the independent prognostic factors for NPC. Including sex, age, KPS, T stage, clinical stage, Ki67 and nm23-H1 may serve as adverse prognostic factors for NPC patients. |
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