CAJ | 학술논문

目的观察肺特异性X蛋白(LUNX)在PN0期非小细胞肺癌(NSCLC)原发病灶和转移淋巴结中的表达,探讨LUNX在PN0期NSCLC淋巴结微转移中的作用.方法收集我院经手术切除且病理检查证实的52例PN0期NSCLC病例,记录各患者性别、年龄、吸烟史、肿瘤性质、浸润程度、淋巴结微转移及TNM分期等临床各项资料.将切除的肿瘤标本和清扫的淋巴结标本,行免疫组织化学染色,并提取肿瘤和淋巴结组织的DNA行聚合酶链反应(PCR)扩增和测序,观察LUNX在PN0期NSCLC原发病灶和转移淋巴结中的表达,并分析临床病理特征和患者术后总体生存的关系.结果 (1) LUNX mRNA在52例肺癌病例的原发灶均表达阳性(100％),327站淋巴结中49站(14.98％)表达阳性,196站纵隔淋巴结中24站(12.24％)表达阳性.(2)影响术后生存和无病生存率的因素包括:LUNX分期(P＜0.01)、纵隔淋巴结微转移(P＜0.01)、清扫淋巴结总站数(P＜0.01)、清扫纵隔淋巴结站数(P＜0.05)、病理分级(P＜0.05).(3)纵隔淋巴结微转移是影响术后无病生存的唯一独立危险因素,有纵隔淋巴结微转移的患者的复发风险是无纵隔淋巴结微转移的患者的21.8倍(P＜0.01).结论通过对PN0期NSCLC原发肿瘤病灶LUNX mRNA蛋白表达的检测,研究其与淋巴结微转移以及患者预后的关系.可以更加精确地预测早期NSCLC患者的预后,减少术后治疗的盲目性,改善疗效.
목적 관찰폐특이성X단백(LUNX)재PN0기비소세포폐암(NSCLC)원발병조화전이림파결중적표체,탐토LUNX재PN0기NSCLC림파결미전이중적작용.방법 수집아원경수술절제차병리검사증실적52례PN0기NSCLC병례,기록각환자성별、년령、흡연사、종류성질、침윤정도、림파결미전이급TNM분기등림상각항자료.장절제적종류표본화청소적림파결표본,행면역조직화학염색,병제취종류화림파결조직적DNA행취합매련반응(PCR)확증화측서,관찰LUNX재PN0기NSCLC원발병조화전이림파결중적표체,병분석림상병리특정화환자술후총체생존적관계.결과 (1) LUNX mRNA재52례폐암병례적원발조균표체양성(100％),327참림파결중49참(14.98％)표체양성,196참종격림파결중24참(12.24％)표체양성.(2)영향술후생존화무병생존솔적인소포괄:LUNX분기(P＜0.01)、종격림파결미전이(P＜0.01)、청소림파결총참수(P＜0.01)、청소종격림파결참수(P＜0.05)、병리분급(P＜0.05).(3)종격림파결미전이시영향술후무병생존적유일독립위험인소,유종격림파결미전이적환자적복발풍험시무종격림파결미전이적환자적21.8배(P＜0.01).결론 통과대PN0기NSCLC원발종류병조LUNX mRNA단백표체적검측,연구기여림파결미전이이급환자예후적관계.가이경가정학지예측조기NSCLC환자적예후,감소술후치료적맹목성,개선료효.
Objective To investigate the detection of lymph node micrometastasis in stage Ⅰ nonsmall cell lung cancers (NSCLC) using lung-specific X protein (LUNX) mRNA as a marker based on reverse transcription-polymerase chain reaction (RT-PCR) and its relationship with the patho-clinical features and prognosis.Methods 52 patients underwent curative lobectomy,excluding pneumonectomy and Palliative resection.Curative lobeetomy included systemic lymph node reseetion,Which meant at least 6 mediastinal lymph node from 3 stations were reseeted.The expression of LUNX mRNA in each station of lymph node were examined by means of RT-PCR.LUNX mRNA was then used as a marker of lymph node micrometastasis.Analyses of relationship between lymph node micrometastasis and the pathoclinical features,overall survival and disease free survival were then carried out.Results The expression of LUNX mRNA:none was positive for all ten lymph nodes from benign diseases.All 52 lung cancer tissues showed positive expression,14.98％ of lymph nodes and 12.24％ of mediastinal lymph nodes showed positive expression,so that the LUNX stage was upgraded.Survival affecting factors included:LUNX stage (P ＜ 0.01),mediastinal lymph nodes micrometastasis (P ＜ 0.01),number of lymph nodes and mediastinal lymph nodes resected (P ＜ 0.05),pathological differentiation (P ＜ 0.05).Those with mediastinal lymph nodes micrometastasis had a 21.8 folds higher risk of death than those without (P ＜ 0.01).Conclusion The expression of LUNX mRNA in lymph nodes is related to overall survival and disease free survival,and is a reflection of lymph nodes micrometastasis.The subgroup of stage propidium iodide (PI) patients with high risks can be thus found.This technique is helpful in restaging patients more accurately.Survival can be improved if interference is applied in early stage.