I期非小细胞肺癌的分子预后

Molecular Prognostic Strategy in Patients with Stage-I NSCLC

目的 联合检测I期非小细胞肺癌（NSCLC）的细胞增殖、凋亡和血管生成，探讨I期非小细胞肺癌预后分层。方法应用免疫组织化学方法检测118例I期非小细胞肺癌、30例肺良性组织和30例正常肺组织血管内皮生长因子（VEGF）的表达，应用比Ki67标记检测细胞增殖指数（PI）。TUNEL法检测70例I期非小细胞肺癌，30例正常肺组织凋亡指数（AI）。结果单因素分析结果表明，肿瘤血管浸润、VEGF高表达、高PI、低AI为I期非小细胞肺癌的不良预后因素。多因素分析结果显示，肿瘤血管浸润（BVI、VEGF及PI可以作为影响I期非小细胞肺癌预后的独立因素。根据免疫组化综合评分（IRS）IRS=VEGF＋PI＋AI，将患者分为低危组及高危组，5年总体生存率分别为82．22％、23．33％，有显著性差异（P=0．0056）。综合评分可作为独立预后因素（RR=4．878，95％CI：1．379～17．258，P=O．014）。结论联合检测肿瘤的细胞增殖、凋亡和血管生成，可能实现对I期非小细胞肺癌的预后分层，判断预后以及指导治疗。

Objective To evaluate the prognostic implications of angiogenesis assessed by vascular endothelial growth factor （VEGF）, proliferation index （PI） and apoptotic index （AI） in patients with stage - I non - small cell lung cancer treated with radical resection. Methods 118 patients undergoing complete surgical resection of pathological stage-I non - small cell lung cancer from 1994 - 2002 were retrospectively reviewed. Tumor specimen were analysed by immunohistochemical assay for VEGF expression and Ki67. AI were detected by TUNEL assay. All data were analyzed by SPSS 11.5 statistic software. Results In univariate analysis,patients with the presence of vascular invasion,high VEGF expression,high PI or low AI had significantly poor overall surviral. In multivariate analysis,vascular invasion, high VEGF,high PI and IRS （ Immunoreactive Score） were significantly independent predictive factors for overall survival. Patients were divided into high risk and low risk group according to IRS. Patients in the high risk group had a significantly lower overall survival rate than that in the low risk group. Conclusion Combined analyses of VEGF,PI and AI could provide a helpful prognostic model in stage- I non-small cell lung cancer treated by surgical resection and may improve prognostic stratification for adjuvant therapy after surgery.