CA-9、CD1a、CD3和EGFR在Ⅰ期非小细胞肺癌中的表达及临床意义

Expression of CA-9,CD1a,CD3 and EGFR in Stage Ⅰ Non-small Cell Lung Cancer

目的:研究低氧标记物CA-9、肿瘤侵袭相关的EGFR表达、与肿瘤免疫功能有关的DC,T淋巴细胞浸润、以及肿瘤坏死程度在Ⅰ期非小细胞肺癌患者中的临床和预后意义。方法:应用免疫组化法检测59例I期非小细胞肺癌患者的CA-9、CD1a、CD3和EGFR的表达。结果:CD1a、CD3和EGFR在腺癌中的表达明显高于鳞癌(P<0.05);CA-9高表达和肿瘤高坏死者,其肿瘤中的CD1a浸润低(P<0.05);肿瘤高坏死的患者,生存率明显低于低坏死者(P<0.05);术后化疗组与未化疗组在生存率上未发现有显著性差异,但进一步分层分析显示:在CA-9阳性表达和CD1a阴性的患者中,术后化疗组的生存率明显短于未行化疗组(P<0.05)。结论:非小细胞肺癌早期即有免疫细胞的浸润,肿瘤低氧、不同病理学类型和肿瘤的坏死程度可能影响免疫细胞的浸润;肿瘤的坏死程度影响患者的生存率;检测CA-9和CD1a的表达可能对Ⅰ期非小细胞肺癌患者术后是否应该化疗有指导意义。

Objective： To evaluate expression of CA-9, CD1a, CD3 and EGFR in Stage Ⅰ non- small cell lung cancer （NSCLC） and to analyze the clinical and prognostic significance. Methods： Expression of CA-9, CD1a, CD3 and EGFR was measured in 59 stage Ⅰ NSCLCs by immunohistochemistry. The extent of tumor necrosis was also analyzed. Results： CD1a, CD3 and EGFR expression was higher in adenocarcinoma than in squamous carcinoma （P〈0.05）. CD1a infiltration was lower in patients with positive CA-9 expression and with extensive tumor necrosis （P〈0.05）. The patients with extensive tumor necrosis had shorter overall survival than those with minimal necrosis （P〈 0.05）. There was no difference in survival between patients who received chemotherapy and those who did not. Further analysis indicated the overall survival of patients who received chemotherapy was shorter than that found in patients who did not receive chemotherapy if the tumors were positive for CA-9 expression （P〈0.05） and negative for CD1a infiltration （P〈0.05）. Conclusion： Infiltration of CD1a ＋DCs and CD3 ＋T lymphocytes can be observed in early stage NSCLCs. Tumor hypoxia, histopathology and the extent of tumor necrosis may affect this infiltration. The extent of tumor necrosis was strongly correlated with overall survival. The expression of CA-9 and CD1a may be used to help clinicians decide the best course of treatment, especially in terms of chemotherapy.