CgA和SYN在非小细胞肺癌中的表达及与预后的关系

Expression and prognostic significance of CgA and SYN in patients with non-small cell lung cancer

目的研究神经内分泌分化（ND）标志物嗜铬蛋白A（CgA）和突触素（SYN）在可切除的非小细胞肺癌（NSCLC）组织中的表达及其与预后的关系。方法2000年1月～2003年1月收治NSCLC且接受手术治疗的患者共123例。收集手术切除标本以及患者临床和术后随访资料等。应用免疫组化二步法检测肿瘤组织标本中CgA和SYN的表达；分别采用Kaplan．Meier生存曲线和Cox风险比例模型进行单因素和多因素生存分析。结果切除的肿瘤组织标本中CgA和SYN的阳性表达率分别为22％和17．9％；SYN阳性表达与肿瘤分化程度相关（P=0．001）；NSCLC伴ND（NSCLC—ND）（CgA和SYN任意一项表达阳性）与患者性别、年龄、吸烟指数、TNM分期和病理类型无明显相关。耐受化疗次数在CgA、SYN呈阳性表达与阴性表达的NSCLC患者之间无明显差异（P=0．406）。Kaplan—Meier生存分析显示，CgA和SYN表达与患者生存期相关；Cox多因素分析表明，肿瘤组织中SYN阳性表达（P=0．001）、TNM分期（P=0．02）和最大直径（P=0．049）是影响患者预后的独立危险因素。结论NSCLC—ND患者预后较差，其标记物SYN可作为临床判断预后的指标之一。

Objective To study the expression and prognostic significance of neuroendocrine differentiation markers chromogranin A （CgA）and synaptophysin （SYN） in patients with resectable non-small cell lung cancer （NSCLC）. Methods From January 2000 to January 2003, 123 patients with NSCLC who received operations were investigated. The resected specimens and clinical data were collected. Immunohistochemical Elivison method was used to detecte the expression of CgA and SYN. Kaplan-Meier survival curve and Cox proportional hazard model multivariate analysis were applied for the prognostic factors. Results The positive expression rates of CgA and SYN were 22%, 17. 9%, respectively. The expression of SYN was associated with histological differentiation （P =0. 001）. No significant association was found between NSCLC with neuroendocrine differentiation （NSCLC-ND） and sex, age, smoke index, TNM Stage and pathology classification. No evidence showed the patients wit~ positive expression of CgA or SYN could be tolerant with more cycles of chemotherapy （P = 0. 406）. Kaplan-Meier survival curve indicated the survival had a relation with the expression of CgA and SYN. It was revealed by Cox analysis that SYN （P =0. 001 ） ,TNM stage （P =0.02）and the maximal diameter of tumor （P = 0. 049 ） were independent prognostic factors. Conclusion The patients with NSCLC-ND had a poorer prognosis. SYN may be one of the prognostic factors in patients with NSCLC.