神经内分泌分化在非小细胞肺癌新辅助化疗疗效中的价值

Clinical value of neuroendocrine markers for neoadjuvant chemotherapy response in patients with non-small-cell lung cancer(NSCLC)

背景与目的：非小细胞肺癌预后较差，近期研究发现非小细胞忡癌中有部分含有神经内分泌（Nemoendocrine，NE）颗粒，目前对含有NE颗粒的非小细胞肺癌的化疗疗效国内外尚有争议。本工作综合应用电镜、免疫组化和影像学分析研究非小细胞肺癌伴神经内分泌分化与化疗疗效的关系。方法：对62例NSCLC患者进行含铂类方案1～2个疗程的新辅助化疗，通过影像学判定化疗疗效。然后进行手术治疗，术后标本用光镜观察其组织病理学疗效、电镜观察NE颗粒、免疫组化法检测NE标记（CgA、Syn）。结果：本组病例NE标记阳性29例，阴性33例，阳性率为46．8％。在影像学上：NE分化阳性患者中有10例部分缓解（PR），19例为无效（NR）；阴性患者中有5例为PR，28例为无效（NR），但统计学上差异无显著性（P=0．069）。在组织病理学上：NE分化阳性患者中有21例组织学有效；阴性患者中有10例达到组织学有效，NE分化阳性的NSCLC患者化疗后病理组织学疗效较阴性者好（P=0．023）。结论：NSCLC中NE分化阳性的患者对化疗较敏感。

Background and purpose： Prognosis of NSCLC is poor . Recent studies have found that some NSCLC have NE granules . The clinical value of NE for chemotherapy re,pone in patients with NSCLC is unknown. Our study was to investigate the relationship between NE differentiation and theirespnnse to chemotherapy for the patients with NSCLC. Methods： 62 cases of NSCLC proved by pathological or cytological examination were studied. The patients were operated af- ter one or two courses of platin-based chemotherapy. The markers of NE, chromogranin A （CgA） and synaptophysin （Syn） were detected with immunohistoehemistry （ EnVision method）. NE granules of NSCLC were observed with Electron microscope. NE differentiation was scored as either neuroendocrine granules positive by electron microscopy or CgA, Syn positive by immunohistochemistry in the specimens. The relationship between NE differentiation and the effect of neoadjuvant chemotherapy were evaluated, judged by imaging and pathological change after neoadjuvant chemotherapy. Results： Positive rate of NSCLC with NE differentiation markers was 46.8%. The histological response rate of neoadjuvant chemotherapy for the patients with NE positive were higher than the patimts with NE negative（ P = 0. 023） ; compared with NE negtive cases, NSCLC patients with NE differentiation had no significant difference in terms of neoadjuvant chemotherapy respones estimated by imaging change（ P = 0. 069）. Conclusions： NSCLC patients with NE had better neoadjuvant chemotherapy response judged by pathological examination.