p27^(kipl)及ki-67在非小细胞肺癌中表达的预后意义

Prognostic significance of the expressions of p27^(kipl) and ki-67 in non-small cell lung cancer

目的:探讨抑癌基因p27kipl与细胞核增殖相关的抗原ki鄄67在非小细胞肺癌中的表达,分析两者之间的关系及其对预后的影响。方法:采用免疫组织化学方法对64例非小细胞肺癌术后病理标本中p27kipl及Ki鄄67进行检测。结果:肺癌组织中平均p27kipl标记42.39%。p27kipl表达水平的下降与组织学分级(P<0.05)、淋巴结受侵(P<0.01)、高肿瘤增殖活性(P<0.001)密切相关;高Ki鄄67标记与淋巴结转移有关(P<0.05)。p27kipl与Ki鄄67之间呈负相关(r=鄄0.472,P<0.001)。Kaplan鄄Meier生存分析显示,p27kipl高表达者中位生存期39个月,而低表达者14个月(P<0.01);Ki鄄67低表达者中位生存期32个月,而高表达者13个月(P<0.01)。在p27kipl与Ki鄄67相结合的预后判断中,高Ki鄄67/低p27的患者病情进展快,生存期短,低Ki鄄67/高p27表达的患者生存期明显延长。生存期的COX单因素分析表明,p27kipl、Ki鄄67、组织学分级、淋巴结转移具有统计学意义,而多因素分析中仅p27kipl、Ki鄄67、淋巴结转移是独立的预后因素。结论:淋巴结转移、p27kipl和Ki鄄67的表达可作为判断预后的指标。而p27kipl、Ki鄄67结合对判断预后及根治术后选择治疗方案具有重要的价值。

Objective: To study the expressions of tumor suppressor gene p27kipl and nucleic proliferation related antigen ki-67 in non-small cell lung cancer(NSCLC), and to study their relationship and impact on prognosis. Methods: We checked the expressions of p27kipl and ki-67 of tissues surgically removed from 64 patients with NSCLC using the method of immunohistochemistry. Results: The decline of the expression of p27kipl was closely related to histological grade(P<0.05), lymph node metastasis(P<0.01), and high tumor proliferation (P<0.001); high ki-67 marker was related to lymph node metastasis(P<0.05). There was an obvious negative mutuality between p27kipl and ki-67 (r=-0.427, P<0.001). Kaplan-Meier survival analysis showed that the median survival time was 39 months in patients with high p27kipl expression and 14 months in those with low p27kipl expression (P<0.01); the median survival time was 32 months in patients with low ki-67 expression while 13 months in those with high ki-67 expression (P<0.01). Patients with high ki-67/low p27 expression had short survival time, but the survival time of those with low ki-67/high p27 expression prolonged obviously. The COX univariate survival analysis showed that p27kipl, ki-67, histological grade, and lymph node metastasis were important influ encing factors, but multivariate analysis showed only p27kipl, ki-67, and lymph node metastasis were independent prognostic factors. Conclusion: p27kipl, ki-67 and lymph node metastasis can be used to make prognosis. It is more valuable to combin p27kipl and ki-67 to make prognosis and select auxiliary treatment measures after curative resection.