探讨卵巢癌干细胞(OCSC)标志物CD₁₃₃、CD₄₄在不同类型上皮性卵巢癌(EOC)组织表达的差异及其意义。

选择2003年1月1日至2016年12月31日，四川大学华西第二医院收治的15例复发EOC患者，30例术前未接受化疗、30例术前接受新辅助化疗(NACT)的初发晚期EOC患者为研究对象，分别纳入复发组(n＝15)、未化疗组(n＝30)、NACT组(n＝30)。对复发组EOC初发与复发时手术切除组织，以及未化疗组与NACT组手术切除组织，采用免疫组化方法测定其CD₁₃₃、CD₄₄阳性表达率及光密度值(OD)。复发组EOC初发与复发时手术切除组织CD₁₃₃、CD₄₄阳性表达率及OD比较，分别采用配对χ²检验和Wilcoxon符号秩和检验。未化疗组与NACT组手术切除EOC组织上述指标比较，分别采用χ²检验和Wilcoxon秩和检验。采用Cramer′s V系数分析EOC组织的CD₄₄与CD₁₃₃表达相关性。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》的要求。3组患者的年龄、病理分型和分级等一般临床资料比较，差异均无统计学意义(P>0.05)。

①复发组EOC初发与复发时手术切除组织CD₁₃₃阳性表达率及OD(CD₁₃₃、CD₄₄)分别比较，差异均无统计学意义(P>0.05)；复发时手术切除组织CD₄₄阳性表达率为86.7%(13/15)，高于初发时的73.3%(11/15)，2者比较，差异有统计学意义(χ²＝4.922、P＝0.027)。②NACT组手术切除组织OD(CD₁₃₃、CD₄₄)及CD₄₄阳性表达率，均高于未化疗组，差异均有统计学意义(Z＝－2.176、P＝0.030，χ²＝5.455、P＝0.020，Z＝－4.759、P<0.001)。③EOC组织中CD₄₄与CD₁₃₃表达具有相关性(Cramer′s V＝0.462、P<0.001)。

OCSC标志物CD₁₃₃与CD₄₄在EOC组织中的表达具有相关性，可能在OCSC表面同时存在。化疗后OCSC残留，可能为导致EOC复发的真正原因。

To explore the differential expressions of ovarian cancer stem cells (OCSC) markers CD₁₃₃ and CD₄₄ in primary and recurrent epithelial ovarian cancer (EOC) tissues and its significances.

From January 1, 2003 to December 31, 2016, a total of 15 patients with recurrent EOC, 30 primary EOC patients with advanced stage who did not receive chemotherapy before surgery, and 30 primary EOC patients with advanced stage who received neoadjuvant chemotherapy (NACT) before surgery in West China Second University Hospital, Sichuan University were selected as research subjects, and they were included into the recurrent group (n=15), non-chemotherapy group (n=30), and NACT group (n=30). The positive expression rates and optical density (OD) of CD₁₃₃ and CD₄₄ in different types of EOC tissues were detected by immuohistochemistry. Paired chi-square test and Wilcoxon signed rank sum test were used to compare the positive expression rates and OD of CD₁₃₃ and CD₄₄ between EOC tissues of primary and recurrent surgery in recurrent group. Chi-square test and Wilcoxon rank sum test were used to compare the positive expression rates and OD of CD₁₃₃ and CD₄₄ between EOC tissues of non-chemotherapy group and NACT group. Correlation analysis of CD₄₄ and CD₁₃₃ expressions in EOC tissues was analyzed by Cramer′s V coefficient. This study met the requirements of the World Medical Association Declaration of Helsinki revised in 2013. There were no significant differences in the general clinical data of age, pathological type and grade between the three groups (P>0.05).

①In recurrent group, there were no statistical differences between EOC tissues of primary and recurrent surgery in positive expression rates of CD₁₃₃, and OD of CD₁₃₃ and CD₄₄ (P>0.05). The positive expression rate of CD₄₄ in EOC tissues of recurrent surgery was 86.7% (13/15), which was higher than that in primary surgery [73.3% (11/15)], and the difference was statistically significant (χ²=4.922, P=0.027). ②The OD of CD₁₃₃ and CD₄₄, and the positive expression rate of CD₄₄ in EOC tissues of NACT group all were higher than those of non-chemotherapy group, and all the differences were statistically significant (Z=—2.176, P=0.030; χ²=5.455, P=0.020; Z=—4.759, P<0.001). ③There was correlation between the expressions of CD₁₃₃ and CD₄₄ in EOC tissues (Cramer′s V=0.462, P<0.001).

The OCSC markers CD₁₃₃ and CD₄₄ are co-expressed in EOC tissues and may co-exist on the surface of OCSC. The residue of OCSC after chemotherapy may be the real cause of EOC recurrence.