p53、p21^(WAF1)蛋白在非小细胞肺癌中的表达及其临床意义

Expression and clinical significance of p53 protein and p21^(WAF1 ) in non small-cell lung carcinoma

目的 探讨原发性非小细胞肺癌中p5 3、p2 1WAF1蛋白表达与临床病理及预后的关系。方法 应用免疫组织化学 (SP法 )方法。共检测非小细胞肺癌 147例 ,其中腺癌 6 6例 ,鳞癌 6 3例 ,腺鳞癌 14例 ,大细胞癌 4例。结果 p5 3蛋白总阳性率为 6 1.2 % (90 / 147) ,腺癌为 5 7.6 % (38/ 6 6 ) ,鳞癌阳性率为 6 3.5 % (4 0 / 6 3) ,腺鳞癌为 71.4% (10 / 14) ,大细胞癌 2例阳性。p2 1WAF1蛋白总阳性率为40 1% (5 9/ 147) ,腺癌为 42 .4% (2 8/ 6 6 ) ,鳞癌为 41.3% (2 6 / 6 3) ,腺鳞癌 2 8.6 % (4 / 14) ,大细胞癌 1例阳性。肺腺癌p5 3蛋白阳性表达与其预后相关 ,6 6例腺癌中 ,生存率低于 3年组和高于 3年组的p5 3蛋白阳性率分别为 75 % (2 1/ 2 8)和 44 .7% (17/ 38) ,差异有显著性意义 (P <0 .0 2 5 )。p2 1WAF1阳性表达与肺癌预后有关 ,p2 1WAF1阳性表达者 3年生存率 (6 4.4% )高于阴性表达者 (4 6 .6 % ) (P <0 .0 5 )。p5 3阳性而p2 1WAF1阴性的非小细胞肺癌患者的预后比p5 3阴性而p2 1WAF1阳性者差 (P <0 .0 1)。结论 检测p5 3蛋白表达可作为判断肺腺癌预后的指标之一 ;检测p2 1WAF1蛋白表达有利于对非小细胞肺癌预后的判断 ;联合检测p5 3、p2 1WAF1蛋白对判断非小细胞肺癌的预后有重要的意义 。

Objective To investigate the relationships between expression of tumor suppressor gene p53 protein, p21 WAF1 , clinicopathology and prognosis in human non small cell lung carcinoma (NSCLC). Methods SP immunohistochemistry performed in all cases. Results One hundred forty seven resected NSCLC were examined. There were 63 squamous cell carcinomas, 66 adenocarcinomas, 14 adenosquamous carcinomas and 4 large cell carcinomas. Overall 90 (61.2%) of the 147 cases had positive p53 staining. The positive ratios of p53 overexpression of squamous cell carcinomas, adenocarcinomas, adenosquamous carcinomas and large cell carcinomas were 63.5%(40/63), 57.6%(38/66), 71.4%(10/14) and 50%(2/4) respectively. The average positive ratio of p21 WAF1 expression was 40.1% (59/147) in lung carcinoma. The positive ratios of p21 WAF1 expression of squamous cell carcinomas, adenocarcinomas, adenosquamous carcinomas and large cell carcinomas were 41.3%(26/63), 42.4% (28/66), 28.6% (4/14) and 25% (1/4) respectively. Over expression of p53 protein was associated with prognosis of the patients with adenocarcinomas. The positive ratio of p53 expression in over 3 year survival patients was 75% (21/28) and in less than 3 year survival, 44.7% (17/38) ( P <0.025). The positive expression of p21 WAF1 was related to prognosis of NSCLC. The ratio of 3 year survival (64.4%) in p21 WAF1 positive NSCLC was much higher than in p21 WAF1 negative patients (46.6%) ( P <0.05). Prognosis of patients with p53 positive but p21 WAF1 negative expression was poorer than those with p53 negative and p21 WAF1 positive NSCLC ( P <0.01). Conclusion These findings suggest that over expression of p53 in adenocarcinomas could be used as a prognostic factor for patients. p21 WAF1 is of protein has a definite value in judging the prognosis in NSCLC. Combined expression of p53 and p21 WAF1 can be used as the prognostic markers in NSCLC and are of significance in estimating the prognosis of patients.