The Clinical Analysis of Nasal Endoscopy Surgical Treatment for Sinonasal Inverted Papilloma and Investigation of the Expression and Clinical Significance of Sruvivin and Caspase-3
|School||Southern Medical University,|
|Keywords||Sinonasal inverted papilloma Survivin Caspase-3 Inhibitor of apoptosis Immunohistochemistry Relapse Malignant|
Approach to select the first part of the nasal cavity and sinuses, the inverted papilloma nasal endoscopy surgery efficacy analysis research background sinonasal inverted papilloma (Sinonasal inverted papilloma, SNIP) in the epithelium of the mucous membrane of the nasal cavity and paranasal sinuses borne benign tumor incidence of 0.4% -4.7% of the total nasal tumor. Mostly occurs in middle-aged men, its main clinical features of relapse after surgery, the destruction of surrounding anatomical structures and bone remodeling associated with squamous cell carcinoma, surgery is the treatment of choice. History of the use of the the nasal incision external nasal surgical approach treatment of such diseases, surgical injury, bleeding, longer hospital stay, some patients legacy facial scars. Extension and development in recent years, endoscopic techniques, endoscopic sinus surgery and endoscopic nose inside and outside the joint approach to the treatment of the disease, the main technical means, but the classification of different tumor which surgical approach and clinical efficacy relations need to explore. The aim of the present study was to investigate Endoscopic nasal sinus inverted papilloma choice of surgical approach and efficacy. Methods Retrospective analysis of Affiliated School of Otolaryngology - Head and Neck Surgery August 1996 to February 2008 menstrual endoscopic sinus surgery for sinonasal inverted papilloma 91 cases clinical data. 91 patients, 62 males and 29 females; ages 23-70 years, mean 48.6 years. Domestic SNIP installments Krouse staging. Krouse (2000) based on endoscopy, CT / MRI to determine tumor range proposed disease staging system: I complete tumor confined to the nasal cavity, confined to the nasal cavity of a wall or a zone, not involving the sinuses and nasal organizations , non-malignant; Ⅱ: tumor invasion OMC body and ethmoid and / or maxillary sinus inner wall and the upper wall and / or without nasal involvement, malignant; Ⅲ: lesions involving the maxillary sinus lateral wall of , the front and rear walls or invasive frontal sinus, sphenoid, malignant; Ⅳ: lesions outside the structure or malignant sinonasal violations. The 91 patients were divided into four: 18 cases of grade Ⅰ, Ⅱ grade 45 cases, 25 cases of grade III, Ⅳ grade three cases according to Krouse classification. Simple endoscopic surgery group (A) Ⅰ 18 cases, Ⅱ grade 33 cases, Ⅲ grade 13 cases; combined with modified Caldwell - Luc surgical, endoscopic sinus surgery group (B) Ⅱ, 12 cases, Ⅲ grade 12 cases; approach joint endoscopic nasal surgery group (C) IV 3 cases. Surgery: intraoperative surgical methods to decide based on the location and extent of tumor invasion of the tumor pedicle. Take ① section resection: For Krouse Ⅰ and Ⅱ stage patients, according to the location of the tumor pedicle, the pedicle where anatomical units en bloc. (2) expand the segment resection involving patients with maxillary sinus wall: For Krouse Ⅱ level, open ethmoid, expansion of the maxillary sinus ostium, where appropriate, the lateral wall of the nasal cavity, the removal of the maxillary sinus and ethmoid tumor; Krouse Ⅲ level located frontal sinus or sphenoid sinus patients, expanding the frontal recess, open the frontal sinus tumor resection of frontal sinus; invasive sphenoid sinus, bite the exception of the sphenoid sinus anterior wall, remove the tumor and surrounding mucosa, the removal of the open sphenoid sinus tumor. ③ radical resection: For Krouse Ⅲ level widely invading the maxillary sinus lateral wall of the lower wall, radical maxillary anterior or posterior wall underwent nasal endoscopy and improved Caldwell - Luc procedure. (4) extended radical resection: Krouse Ⅳ level in patients with lesions invading the orbital roof wall and frontal sinus posterior wall by nasal endoscopy and frontal sinus anterior wall fenestration dual approach radical tumor resection. Statistical analysis: application the SPSS13.0 software system analysis using Fisher exact test. P lt; 0.05 was considered statistically significant. Postoperative follow-up results were followed up for 18-90 months, an average of 37 months, 15.4% (14/91) recurrence A group Ⅰ 5.6% (1/18) and, grade Ⅱ 6.1% (2/33) , grade Ⅲ 53.8% (7/13); The B group Ⅱ level of 16.7% (2/12),, Ⅲ level 8.3% (1/12); C group Ⅳ 33.3% (1/3). Grade Ⅱ cases statistical results suggest no difference in group A and group B recurrence rate; and grade Ⅲ cases, group A and group B recurrence rate difference, A group of high recurrence rate. Relapse cases underwent reoperation, and follow-up of 24 months no recurrence. Conclusion 1. Endoscopic technology advantages: no facial incision, swelling of the face light, shorter hospital stay, reduce postoperative pain and numbness. . Endoscopic surgery for sinonasal inverted papilloma recurrence rate in a reasonable range, better than the nose external approach surgery. 3. Endoscopic surgery for sinonasal inverted papilloma is a safe, effective, minimally invasive method of treatment, most by simple endoscopic sinus approach procedure completed, but for tumors involving the maxillary sinus, frontal extensive sinus lesions Ⅲ, Ⅳ level in patients using the combined approach can avoid surgery blind spot, and to reduce the residual tumor, reduce the relapse rate. 1) Krouse Ⅰ tumor, the tumor is located in the nasal cavity, if the base is exposed clearly, you can be in the the intranasal endoscopic line of simple tumor resection. 2) For Krouse Ⅱ grade tumors, may be considered for full ethmoidectomy, while maximizing the maxillary sinus opening, to facilitate the postoperative follow-up. Papyracea, ethmoid top the diseased mucosa completely clear while emphasizing to retain the integrity of the dura and orbital septum, and pay attention to not damage the bone in order to avoid complications. 3) Krouse grade III tumors ① invading the nasal cavity, ethmoid and sphenoid intranasal inverted papilloma, and the simple endoscopic sinus surgery is more than can be completely removed. ② For Krouse Ⅲ grade tumor violations of the maxillary sinus lateral wall of the lower wall, lesions of the anterior wall, should be taken nasal endoscopy and improved Caldwell - Miss procedure can reduce recurrence. ③ For large frontal sinus tumor involving the frontal sinus lateral or orbital, anterior, passing through the nasal endoscopy and frontal sinus anterior wall fenestration dual approach radical tumor resection. 4) For Krouse Ⅳ grade tumor invasion of the nasal structures such as orbital and intracranial need additional external nasal approach combined surgery in order to completely remove the tumor. The second part of the nasal cavity and sinuses inverted papilloma of Survivin, Caspase-3 Expression and clinical significance of research study background sinonasal inverted papilloma (Sinonasal inverted papilloma, SNIP) originated in sinonasal mucosal epithelial benign tumors, but has locally aggressive recurrence rate and easy malignant characteristics, its incidence and recurrence and malignant transformation mechanism is not yet clear. Survivin is a newly discovered inhibitor of apoptosis gene, its expression of the protein are new members of the inhibitor of apoptosis protein family, inhibit apoptosis and mitosis and cytokinesis plays an important role in the cell . Studies have shown that Survivin is expressed in human tumor tissue during embryonic development and reduced or absent expression in mature terminally differentiated tissues. Survivin gene is cloned by DC.Alfirei, anti-apoptotic gene, plays an important role in cell survival and cell cycle progression. Survivin main features include the inhibition of apoptosis and regulation of cell cycle. Survivin belongs to the IAP family, the family also includes XIAP, clAP1, elAP2, NIAP, ML. IAP and apollon. IAP family members through the baculovirus IAP repeat domain and caspase (pro-caspase-9, caspase-3 and caspase-7) the direct or indirect role in inhibition of apoptosis. On the other hand, Survivin and the inner centromere protein (inner centromere protein), Aurora B kinase and Borealin complex protein together make up the chromosomes passing, precise guidance of sister chromatid separation regulation of the late mitotic microtubule stability, promote cell proliferation. In the period of embryogenesis, Survivin expression of normal cell division and tissue differentiation. Terminally differentiated tissues, Survivin is generally difficult to detect. But in the process of tumor formation, Survivin abnormally high expression. In a variety of human tumors, was positively correlated with the amount of Survivin expression and tumor poor prognosis and high recurrence rate related. Currently, Survivin overexpression can lead to tumor tolerance for a variety of chemotherapy drugs. In addition, the use of specific antisense oligonucleotide targeting interfere with the expression of Survivin able to effectively kill tumor cells. Therefore, Survivin as a cancer treatment in most tumor-specific targets for one by the close attention of scientists. Caspase-3 is the Caspase family is the most important member, the most downstream component caused apoptosis, apoptosis effector molecules involved in a series of apoptosis-related cell changes in the process, including the degradation of intracellular protein substrates, withered inactivation of apoptosis inhibition, after dyeing aggregation prompted formation of apoptotic bodies, etc., are the key enzymes of apoptosis. The purpose of this study focuses on the pathological form of departure from nasal inverted papilloma (Sinonasal inverted papilloma, SNIP), based on the SNIP unique pathological features and Survivin and Caspase-3 biological characteristics and its relationship with tumor immunohistochemistry chemical methods to detect relevant factor Survivin and Caspase-3 expression in the SNIP. Both in the SNIP and relationship, and provide new ways and means for monitoring the clinical and prognostic evaluation of SNIP SNIP treatment provide an objective basis. The method experimental group (SNIP group) to select the SNIP patients in 2003 - 2008 in the Department of Otolaryngology, the Third Affiliated Hospital of Sun Yat-sen University admitted, surgical resection, complete clinical information and follow-up records, review the original HE staining biopsy confirmed evaluable cases 46 cases. 33 cases were male and 13 female. Age 39-70 years, mean 53.8 years. Rabbit anti-human Survivin polyclonal antibody and rabbit anti-human Caspase-3 polyclonal antibody immunohistochemistry Envision two-step method to detect 46 cases of tissue SNIP (SNIP group is divided into the primary group, the recurrence group and malignant group) Survivin and Caspase-3 expression; simultaneous detection of 10 cases of nasal squamous cell carcinoma (Nasal squamous cell carcinoma, NSCC) tissue samples and 10 normal inferior turbinate mucosal tissue expression of Survivin and Caspase-3 as a control study. Statistical analysis: All data use SPSS13.0 statistical analysis, the rate compared using Fisher exact test or X2 test; RXC list correlation X2 test with Survivin and Caspase-3 expression. Survivin and Caspase-3 expression between groups compared using the ordinal segment information rank sum test, multiple comparison methods using Bonffroni Act. P lt; 0.05 was considered statistically significant. Inverted papilloma of the nasal cavity and paranasal sinuses and nasal cavity squamous cell carcinoma of Survivin expression rates were 69.6%, 90.0%, significantly higher than the normal mucosa tissue expression rate of 0% (P lt; 0.01). Caspase-3 expression in squamous cell carcinoma of the nasal cavity was 20%, significantly lower than normal inferior turbinate mucosa expression rate of 100.00% (P lt; 0.01), sinonasal inverted papilloma tissue expression of Caspase-3 The rate was 41.3%, lower than normal mucosa, but the difference between the two is no significant sex (P gt; 0.05). Survivin and Caspase-3 in sinonasal inverted papilloma expression was negatively related (P lt; 0.01). Survivin expression in normal nasal mucosa group, SNIP group, and the SCC group with a significant difference. Survivin SNIP early onset group, expression increased in the relapse group, the malignant group, and the SCC group differences in expression between the groups. Pairwise comparison rank sum test, show the Survivin expression SNIP primary group, and the SCC group, SNIP recurrence group and SCC groups were significant differences between the other two groups showed no significant differences. Caspase-3 in the normal nasal mucosa group and SNIP group, the NSCC group of expression has a significant difference. Caspase-3 expression in SNIP primary group, the relapse group, the malignant group NSCC group gradually weakened, no significant expression difference between the groups. Conclusion 1.SNIP is benign, but it has a high recurrence, easy to malignant transformation of clinical treatment should arouse enough attention. Increased expression 2.Survivin in SNIP, from SNIP early hair the SNIP recurrence between malignant the SNIP and SCC tissue gradually increased the expression of Survivin and Survivin sinonasal inverted papilloma and nasal squamous cell carcinoma, the development of play an important role, may become sinonasal inverted papilloma and nasal squamous cell gene therapy target. 3.Caspase-3 from SNIP early, SNIP recurrence between malignant the SNIP and SCC tissue Caspase-3 expression decreased gradually Tip of Caspase-3 may be involved in the regulation of normal nasal epithelial cell development and transformation of cells during apoptosis Caspase-3 expression down sinonasal inverted papilloma and nasal squamous cell carcinoma, and play an important role in development. The 4.Survivin and Caspase-3 negative correlation between sinonasal inverted papilloma tissue Survivin directly or indirectly inhibit the expression of Caspase-3, reduced apoptosis, also may cause cell proliferation, thereby to promote the progress of the tumor by inhibition of apoptosis and promote cell proliferation dual role. Through detection of Survivin and Caspase-3 has an important reference value for diagnostic and prognostic evaluation of SNIP SNIP treatment of new ideas and effective method.