갑상선 유두암 원발 조직과 재발된 림프절 전이 조직에서 Retinoic Acid Receptor β 단백 발현의 임상적 의의 = The Clinical Significance of Retinoic Acid Receptor β Expressions in Primary and Recurred Metastatic Lymph Node PapillaryThyroid Carcinomas

다국어 초록 (Multilingual Abstract)

Background: The present study was designed to investigate the correlations of retinoic acid receptor β (RARβ) expression for primary and recurred metastatic lymph node (LN) papillary thyroid carcinoma (PTC) tissues and the correlations of RARβ expression with the uptake of I131 as detected on a whole body scan (WBS).Methods: Primary and metastatic LN PTC tissues were examined by immunohistochemical methods. Staining positivity was calculated, and staining intensity was graded as negative (0), weak (1+), moderate (2+) and strong (3+). Nuclear staining intensity (NSI) of cells from tissues was also examined.Results: Seventeen patients who had regional cervical LN metastasis without distant metastasis were included in the study, and 13 patients had the abnormal uptake of I131 as detected on a WBS. In primary PTC tissues, RARβ staining positivity and intensity of carcinoma cells were significantly higher than those of normal cells but NSI was significantly higher in normal cells than carcinoma cells. Between primary and metastatic LN PTC tissues, RARβ staining intensity was correlated after controlling for age. Primary PTC tissues from 14 (82.4%) out of 17 patients were concordant between NSI and the uptake of I131 as detected on a WBS. NSI predicted the I131 uptake as detected on a WBS with 81.3% positive predicted value (PPV) and 100% negative predicted value. Metastatic LN PTC tissues from 13 (76.5%) out of 17 patients were concordant between NSI and the uptake of I131 as detected on a WBS. NSI predicted the uptake of I131 as detected on a WBS with 76.5% PPV. When the results of NSI taken either as positive or negative were correlated with those of the uptake of I131 as detected on a WBS in primary and metastatic LN PTC tissues, the correlation was not significant after controlling for age.Conclusion: Our results demonstrate that nuclear RARβ expression may be decreased in PTC tissues than

국문 초록 (Abstract)

연구배경: 갑상선 유두암의 원발 조직과 재발된 림프절 전이 조직을 대상으로 각 조직의 RARβ 단백 발현 정도 및 관련성을 분석하는 한편 RARβ 단백 발현과 방사성요오드 섭취 여부와의 관련성을 분석하고자 본 연구를 시행하였다.방법: 갑상선 유두암 원발 조직과 림프절 전이 조직에서 RARβ 단백에 대한 면역조직화학염색을 시행하였다. RARβ 단백의 염색 양성도를 각각 계산하였으며 염색 강도를 음성(0), 약한 양성(1+), 중등도 양성(2+), 강한 양성(3+)으로 나누었고 핵 내 RARβ 염색을 확인하였다.결과: 17명의 갑상선 유두암 환자가 포함되었으며 국소 경부 림프절 전이 이외의 원격 전이는 없었다. 전신 방사성요오드 스캔을 시행하였을 때 13명에서 경부 내 비정상적인 섭취가 관찰되었다. 원발 조직에서 정상 세포와 암세포의 RARβ 염색 양성도는 각각 11.5 ± 6.7%와 66.8 ± 14.6%, RARβ 염색 강도는 각각 1.53 ± 0.62와 2.35 ± 0.70이었으며 유의한 차이가 있었다. 림프절 전이 조직에서 암세포의 RARβ 염색 양성도 및 강도는 각각 73.1 ± 15.3%, 2.53 ± 0.51 이었으며 원발 조직 암세포의 RARβ 염색 양성도 및 강도와 차이가 없었다. 원발 조직에서 정상 세포와 암세포의 핵 내 RARβ 염색 강도는 1.53 ± 0.62와 0.94 ± 0.50으로 유의한 차이가 있었으나 원발 조직과 림프절 전이 조직 암세포 사이의 핵 내 RARβ 염색 강도는 차이가 없었다. 모든 환자에서 원발 조직과 림프절 전이 조직 암세포 사이의 RARβ 염색 강도는 나이 제한 후 유의한 상관관계가 있었으나 RARβ 염색 양성도와 핵 내 RARβ 염색 강도는 상관관계가 없었다. 17명 중 14명(82.4%)이 원발 조직 암세포의 핵 내 RARβ 염색 여부와 전신 방사성요오드 스캔 섭취 여부가 일치하였으며 전신 방사성요오드 스캔에 대한 원발 조직 암세포의 핵 내 RARβ 염색의 양성예측도는 81.3%, 음성예측도는 100%이었다. 17명 중 13명(76.5%)에서 림프절 전이 조직 암세포의 핵 내 RARβ 염색 여부와 전신 방사성요오드 스캔 섭취 여부가 일치하였으며 전신 방사성요오드 스캔에 대한 림프절 전이 조직 암세포의 핵 내 RARβ 염색의 양성예측도는 76.5%이었다.

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