TTF-1、NapsinA和Ki-67在非小细胞肺癌中的表达及意义

Expression and significance of TTF-1,Napsin A and Ki-67 in non small cell lung cancer

目的探讨甲状腺转录因子-1(TTF-1)、新天门冬氨酸蛋白酶A(Napsin A)、Ki-67抗原(Ki-67)在非小细胞肺癌(NSCLC)中的表达及意义。方法 NSCLC组织标本104例,其中鳞癌41例,腺癌63例。采用免疫组化方法检测TTF-1、Napsin A、Ki-67表达。结果腺癌患者TTF-1和Napsin A阳性表达率明显高于鳞癌患者(P<0.05),而Ki-67阳性表达率明显低于鳞癌患者(P<0.05);肿瘤大小≤3 cm、TNM分期Ⅰ~Ⅱ期患者TTF-1阳性表达率明显高于肿瘤大小>3 cm、Ⅲ~Ⅳ期患者(P<0.05);高分化患者TTF-1和Napsin A阳性表达率明显高于中低分化患者(P<0.05),而Ki-67阳性表达率明显低于中低分化患者(P<0.05);有淋巴结转移患者Ki-67阳性表达率明显高于无淋巴结转移患者(P<0.05);女性患者Napsin A阳性表达率明显高于男性患者(P<0.05);TTF-1诊断腺癌的灵敏度、特异度、阳性预测值、阴性预测值和准确度分别为73.02%、90.48%、92.00%、69.09%和80.77%;Napsin A诊断腺癌的灵敏度、特异度、阳性预测值、阴性预测值和准确度分别为84.13%、95.12%、96.36%、79.59%和88.46%;Ki-67诊断鳞癌的灵敏度、特异度、阳性预测值、阴性预测值和准确度分别为80.48%、49.21%、50.77%、79.49%和61.54%;TTF-1、Napsin A、Ki-67间表达无相关性(P>0.05)。结论 TTF-1、Napsin A、Ki-67表达与NSCLC患者临床病理特征有关,且TTF-1和Napsin A表达在鳞癌和腺癌鉴别中有较好应用价值。

Objective To investigate the expression and significance of thyroid transcription factor-1(TTF-1),New aspartic proteinase A(NapsinA)and Ki-67 antigen(Ki-67)in non-small cell lung cancer(NSCLC).Methods The expression levels of TTF-1,NapsinA and Ki-67 were detected by immunohistochemisty in 104 cases of NSCLC tissue specimens that were collected in our hospital from February 2015 to February 2017,including 41 cases of squamous cell carcinoma and 63 cases of adenocarcinoma.Results The positive expression rates of TTF-1 and NapsinA in patients with adenocarcinoma were 73.02%and 84.13%,respectively,which were significantly higher than those of patients with squamous cell carcinoma(P<0.05),and the positive expression rate of Ki-67 in patients with adenocarcinoma was 50.79%,which was significantly lower than that of patients with squamous cell carcinoma(P<0.05).The positive expression rates of TTF-1 in patients with tumor size≤3cm,TNM stageⅠ~Ⅱwere 70%and 73.91%,respectively,which were significantly higher than those of patients with tumor size>3cm,TNM stageⅢ~Ⅳ(P<0.05).The positive expression rates of TTF-1 and NapsinA in patients with high differentiation tumor were significantly higher than those of patients with moderate and low differentiation tumors(P<0.05),however,the positive rate of Ki-67 was 46.51%,which was significantly lower than that of patients with middle and low differentiation tumors(P<0.05).The positive expression rate of Ki-67 in patients with lymph node metastasis was significantly higher than that of patients without lymph node metastasis(P<0.05).Moreover the positive rate of NapsinA in female patients was significantly higher than that in male patients(P<0.05).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of TTF-1 in diagnosis of adenocarcinoma were 73.02%,90.48%,92%,69.09%,80.77%,respectively,and which by NapsinA were 84.13%,95.12%,96.36%,79.59%,88.46%,respectively.Besides the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of Ki-67 in diagnosis of squamous cell carcinoma were 80.48%,49.21%,50.77%,79.49%,61.54%,respectively,there were no correlation in the expression levels among TTF-1,NapsinA,Ki-67(P>0.05).Conclusion The expressions of TTF-1,NapsinA and Ki-67 are correlated with the clinicopathological characteristics of patients with NSCLC,moreover,the expressions of TTF-1 and NapsinA have important significance in differential diagnosis between squamous cell carcinoma and adenocarcinoma.