摘要
目的:检测细胞凋亡通路蛋白Mcl1和Fbw7对晚期非小细胞肺癌患者预后的预测作用。方法:收集2008年3月至2011年6月在第四军医大学第一附属医院西京医院确诊晚期非小细胞肺癌且最初两个化疗周期采用"多西他赛+顺铂"方案的患者,通过电话和信件进行随访。用免疫组化方法检测患者肿瘤蜡块组织中蛋白Mcl1和Fbw7表达,用H评分系统将蛋白表达分为高表达组和低表达组。统计采用Kaplan-Meier法进行单因素生存分析并进行Log-Rank检验,通过比例风险模型(Cox模型)逐步后退法进行多因素分析,以P<0.05为有显著差异。结果:共收集病例144例,其中腺癌69例,鳞癌64例,其它11例。Ⅲ期患者45例(31.25%)Ⅳ期患者99例(68.75%).64例(44.44%)患者Mcl1高表达,80例(55.56%)患者Mcl1低表达。单因素结果提示TNM分期是提示预后的显著因素(P=0.033),Ⅲ期患者1年生存率为74.20%(中位生存时间为666天),Ⅳ期患者1年生存率为55.60%(中位生存时间为415天)。Mcl1的表达与晚期非小细胞肺癌预后相关联(P=0.042),其中Mcl1高表达组1年生存率为69.9%(中位生存时间为612天),Mcl1低表达组1年生存率为55.30%(中位生存时间为406天)。多因素分析结果显示Mcl1(OR=1.809,95%CI(1.123-2.912),P=0.015)和TNM分期(OR=0.573,95%CI(0.336-0.978),P=0.041)有独立的预后意义。结论:Mcl1蛋白表达和TNM分期是晚期非小细胞肺癌的独立预后因素,Mcl1高表达组较低表达组有更好的预后,Ⅲ期患者比Ⅳ期患者有更好的预后。
Objective: To detect the Prognostic significance of apoptosis pathway proteins MCL1 and FBW7 in patients with advanced non small cell lung cancer.Methods: Consecutive patients with pathological stage Ⅲ and Ⅳ squamous cell carcinoma(SCC) or adenocarcinoma(ADC) were enrolled retrospectively from Xijing Hospital.Patients who received multidisciplinary treatment modalities and standard supportive care between March 2008 and June 2012 were qualified for this study.We used IHC analysis to determine the expression levels of MCL1 and FBW7 protein in specimens of advanced non-small-cell lung cancer.Patient cumulative survival was analyzed by the Kaplan-Meier method and cumulative survival differences were determined by log-rank test and a Cox regression model adjusted for clinical and pathological factors.Results: The 144 patients,including 64 cases of squamous cell carcinoma,69 cases of adenocarcinoma and 11 other cases.The pathological TNM stages of the patients were stage Ⅲ(45 patients,31.25%) and stage Ⅳ(99 patients,68.75%).Sixty-four(44.44%) patients were observed with high expression levels of Mcl1 and 80(55.56%) with low expression levels of Mcl1.The univariate analysis by log-rank test showed that pathological TNM stage was a significant prognostic factor.The 1-year survival rates of patients were 74.20% for stage Ⅲ(median survival days: 666) and 55.60% for stage Ⅳ(median survival days: 415)(P=0.033).The univariate analysis by log-rank test showed that Mcl1 expression had prognostic significance(P=0.042) while Fbw7 expression had no difference in patient survival(P=0.094).The survival rate of patients at the first year were 69.90% for Mcl1 high expression(median survival days: 612) and 55.30% for Mcl1 low expression(median survival days: 406);there was significant statistically difference(P=0.042).The Cox regression analysis showed that both the expression of Mcl1(HR=1.738,95% CI(1.084-2.787),P=0.008) and pathological TNM stage(HR=0.57,95%CI(0.334-0.973),P=0.039) were independent prognostic factors.Conclusions: This study indicates that Mcl1 protein and Pathological TNM stage both independent prognostic factor for advanced NSCLC.High expression Mcl1 tumors appear to correlate with better prognosis than low expression MCL1 tumors in advanced NSCLC patients.The patients of stage Ⅲ had a better prognosis than those of stage Ⅳ.
出处
《现代生物医学进展》
CAS
2013年第12期2277-2282,共6页
Progress in Modern Biomedicine
基金
国家自然科学基金项目(81272586)