Ⅰ期非小细胞肺癌nm23 VEGF表达与淋巴结微转移关系的研究

The Relationship of nm23 and VEGF Expression with Lymph Node Micrometastasis of Stage I Non-small Cell Lung Cancer

目的:探讨Ⅰ期非小细胞肺癌(NSCLC)nm23、VEGF蛋白表达与肺门淋巴结微转移及预后的关系。方法:采用SP免疫组化法,检测40例根治术后Ⅰ期NSCLC原发灶nm23、VEGF蛋白表达,以细胞角蛋白为淋巴结微转移指标检测86枚肺门淋巴结,分析nm23、VEGF蛋白表达与淋巴结微转移关系,以Kaplan-Meier和Log rank检验进行5年生存资料分析。结果:Ⅰ期NSCLC肺门淋巴结微转移病例阳性率为12.5%。淋巴结微转移与患者性别、年龄、组织学类型、分化程度、肺原发肿瘤大小、VEGF蛋白表达等无统计学相关性(P>0.05),而与原发灶癌组织nm23基因表达负相关(P<0.05)。组织学呈高分化、nm23表达阳性、淋巴结微转移阴性者5年生存率明显好于组织学中-低分化、nm23蛋白表达阴性、淋巴结微转移阳性者(P<0.05)。多因素Cox回归分析显示淋巴结微转移及原发灶nm23蛋白表达是Ⅰ期NSCLC的两个独立预后因素。结论:Ⅰ期NSCLC nm23蛋白表达与肺门淋巴结微转移关系密切,二者是Ⅰ期NSCLC的两个独立预后因素,nm23蛋白表达缺失、淋巴结微转移阳性者预后差。

Objective： To investigate the relationship of nm23 and VEGF expression with hilar lymph node micrometastasis and the prognosis of stage Ⅰ non-small cell lung cancer （NSCLC）. Methods： Immunohistochemistry was used to detect nm23 and VEGF protein expression in primary cancer tissue and cytokeratins in 86 hilar lymph nodes from 40 patients with stage Ⅰ NSCLC. Kaplan-meier method and Log rank test were used to analyze the 5-year survival. Results： The rate of positive hilar lymph node micrometastasis was 12.5% for stage Ⅰ NSCLC. Lymph node micrometastasis was not statistically correlated with gender, age, histologic type, differentiation, primary tumor size or VEGF protein expression （P〉0.05）. But it was reversely associated with nm23 protein expression in primary cancer tissue of NSCLC （P〈0.05）. The 5-year overall survival of patients with well-differentiated NSCLC, positive nm23 expression and negative lymph node micrometastasis was better than those with moderately and poorly differentiated NSCLC, negative nm23 expression and positive lymph node micrometastasis （P〈0.05）. Lymph node micrometastasis and nm23 protein expression were identified as two independent prognostic factors for stage l NSCLC by univariate Cox regression analysis. Conclusion： nm23 protein expression in primary cancer tissue of stage Ⅰ NSCLC is closely associated with hilar lymph node micrometastasis, nm23 protein and hilar lymph node micrometastasis are two independent prognostic factors for stage Ⅰ NSCLC. Patients with nm23 protein deletion and positive lymph node micrometastasis have a poor prognosis.