Ⅲa(T1N2M0)期非小细胞肺癌临床和预后影响因素分析

The clinical and prognotic analytic of Ⅲ_a( T_1N_2M_0) NSCLC

目的:回顾性分析Ⅲ_a(T_1N_2M_0)期非小细胞肺癌(NSCLC)的临床及预后影响因素,并检测核苷酸切除修复交叉互补组1(ERCC1)和细胞角蛋白19(CK19)等与肿瘤发生、侵袭及转移相关的指标在本组肺癌组织中的表达情况,以此探讨此类型NSCLC的临床及生物学特征。方法:选取2000年1月1日至2003年12月31日在天津医科大学肿瘤医院肺部肿瘤科入院行手术治疗的49例Ⅲ_a(T_1N_2M_0)期患者,对其病历资料进行随访。收集上述患者的肿瘤组织石蜡切片,采用免疫组织化学方法(SP法),检测ERCC1、CK19等指标在上述类型NSCLC中的表达状况,并进一步分析其与临床病理分期及预后的关系。结果:本组共49例NSCLC患者,总体1年、3年、5年生存率分别为79.59%、30.61%、12.24%。ERCC1和CK19的阳性率分别为38.78%和42.86%。单因素分析:肿瘤直径、纵隔淋巴结是否单站转移和是否行免疫治疗对本组患者的预后影响有统计学意义(P<0.05);Cox回归多因素分析提示肿瘤直径(P=0.048)、纵隔淋巴结是否单站转移(P=0.045)、ERCC1和CK19的表达情况是影响患者总生存率的独立因素。结论:Ⅲ_a(T_1N_2M_0)期NSCLC预后优于其他临床N2期肺癌。ERCC1、CK19的表达、肿瘤直径、纵隔淋巴结是否单站转移是影响本组患者预后的独立因素。

Objective： To study the clinic characteristics and prognostic factors of stage Ⅲa（ T1N2M0） NSCLC. To evaluate the expression and clinical significance of excision repair cross- complementing 1（ ERCC1）,cytokeratin 19（ CK19）,and investigate the value of these factors in identification of the prognosis. Methods： Clinical data of 49 in patient cases in The Cancer Hospital of Tianjin Medical University,from 2000. 1. 1- 2003. 12. 31,were retrospectively reviewed. Expression of ERCC1 and CK19 was studied by immunohistochemistry in surgically resected NSCLC specimens. The value of three factors in identification of the prognosis was examined by survival analysis. Results： The overall 1,3 and 5- year survival rates were 79. 59%,30. 61%,12. 24% respectively. All the ERCC1 and CK19 had positive result in this experiment. The positive rate of ERCC1 and CK19 were 38. 78% and 42. 86%. The main prognostic factors were tumor diameter,if single station of mediastinal lymph node metastasis（ yes / not） and immunotherapy（ P〈0. 05）. Cox regression suggested that tumor diameter and if single station of mediastinal lymph node metastasis（ yes/not）,ERCC1 and CK19 were independent factors affecting the prognosis of stage Ⅲa（ T1N2M0） NSCLC. Conclusion： Stage Ⅲa（ T1N2M0） NSCLC is an special type of N2 stage NSCLC that has a special biological behaviour,as well as a special clinical,radiological and pathological presentation. The overall survival rate of idencial Ⅲapatients was superior to those with clinical N2（ NSCLC）. Tumor diameter and if singale station of mediastinal lymph node metastasis（ yes / not）,ERCC1 and CK19 were independent factors.