胸水脱落细胞DNA含量及VEGF、p53表达对肺癌胸腔积液治疗和预后的预测

DNA content,the expression of VEGF and p53 in pleural effusion can predict the cure and prognosis

目的:探讨胸水细胞的DNA倍体以及VEGF、p53表达与恶性胸腔积液治疗疗效的关系和对湿性肺癌预后的预测价值。方法:随访43例恶性胸腔积液患者的生存期,39例用图像细胞光度技术(ICM)检测DNA含量,免疫组化Envision法检测VEGF、p53,29例经胸腔引流术后胸腔内药物治疗。结果:DNA异倍体与胸水治疗的疗效有相关趋势(P=0.054)。经Cox多因素分析,仅p53是肺癌胸腔积液患者影响预后的独立因素(P=0.05)。p53阴性组与p53阳性组的中位生存期分别为(10.4±3.5)个月,(2.8±0.6)个月(logrank=0.0132)。一年生存率p53阴性组与阳性组分别为17.7%和0。结论:ICM检测胸水细胞的DNA倍体与胸水治疗的疗效有相关趋势。免疫组化检测p53能预测肺癌胸腔积液患者的预后。

Objective： To investigate the association of nuclear DNA content and vascular endothelial growth factor （VEGF） and p53 expression with therapeutic response of malignant pleural effusion and their value in predicting the prognosis of wet lung cancer. Methods： The survival periods of 43 lung cancer patients with pleural effusions were followed up. The DNA content of 39 patients was measured by the image cytometry （1CM） and the expression of VEGF and p53 was determined by Envision immunohistochemical method. Twenty-nine patients were given bleomycin or interleukin-2 intrathoracically after drainage. Results： DNA aneuploid had a tendency to correlate with therapeutic efficacy of malignant pleural effusion （P = 0. 054）. Cox multivariate analysis showed that only p53 expression was independent prognostic factor for lung patients with pleural effusion （ P = 0.05 ）. The median survival time of patients was （ 10.4±3.5 ） months for p53-negative patients and （2.8±0.6） months for p53-positive patients （log rank =0. 013 2）. One-year survival rate was 17.7% for p53-negative patients and 0% for p53-positive patients. Conclusion： DNA content measured by ICM tended to correlate with the therapeutic efficacy of malignant pleural effusion ; p53 expression is a unique independent prognostic factor for lung cancer patients with pleural effusions.