微小乳头状肺腺癌患者预后评价及免疫组化分析

Micropapillary lung adenonocarcinoma: A distinctive histologic subtype with prognostic signficance

目的对微小乳头状肺腺癌患者的预后进行评价,并根据免疫组织化学构型确定此型肺癌的生物学行为是否有不同。方法 63例经手术切除的肺腺癌病例中的微小乳头状肺腺癌21例和无微小乳头状肺腺癌42例,对其中有微小乳头的12例Ⅰ期病变和无微小乳头的23例Ⅰ期病变进行对比研究。结果研究结果表明,在Ⅰ期病变中,有微小乳头和无微小乳头的病例5年生存率分别为52%和73%(log,P=0.03)。影响生存多变量分析发现,微小乳头成分是一项重要的预后因素(危险比率3.2)。不同免疫标记物在Ⅰ期微小乳头状腺癌中的表达对预后意义的评价表明,非多变量性生存分析发现两种病变只有Cyclin DI和Bax表达与生存差异有相关性(log P=0.03和P=0.02)。结论对肺腺癌中微小乳头的认识至关重要,而Cyclin DI和Bax表达可作为预后不良的标记物。

Objective To evaluate the prognostic significance of the micropapillary lung adenoearcinoma and to determine the biological behavior of this type of lung cancer according to the immunehistoehemical configurations. Methods The 63 cases of resected lung adenocarcinoma included 21 cases of micropapillary lung adenoearcinoma and 42 cases of non-mieropapillary lung adenonocarcinoma. The lesions in 12 cases of micropapillary lung adenocarcinoma at stage Ⅰ and in 23 cases of non-mlcropapillary lung adenocarclnoma at stage Ⅰ were compared. Results The 5-year survival rates of the cases of the micropapillary lung adenocarcinoma and the cases of non-micropapiUary lung adenocarcinoma were 52% and 73% respectively （log rank P = 0. 03 ）. The multivariate survival analysis showed that micropalliary component was an important factor for prognosis with the survival risk ratio being 3.2. The prognostic value was evaluated according to the different expressions of immunologic marks of micropapiUary lung adenocarcinoma at stage Ⅰ . Only the expressions of Cyclin DI and Bax were related with significantly worse survival（log rank P = 0. 03 和 P = 0. 02）. Conclusion It is important to identity micropapillary lung adenocarcinoma and Bax and Cyclin DI can act as marks of poor grognosis.