非小细胞肺癌患者血清外泌体c-myc mRNA表达及预后关系

Expression of serum exosome c-myc mRNA and its relationship with prognosis in patients with non-small cell lung cancer

目的:探究血清外泌体c-myc mRNA在非小细胞肺癌(NSCLC)患者中的表达情况,并分析其与患者的预后关系。方法:选取2017年1月~2019年3月105例NSCLC患者(肺癌组),另选60例良性肺病(良性组)、60例体检健康者(健康组),采用差异超速离心法提取血清外泌体,透射电镜法及蛋白免疫印迹法鉴定,实时荧光定量检测PCRc-myc mRNA相对表达量。比较肺癌组、良性组与健康组血清外泌体c-myc mRNA水平,分析血清外泌体c-myc mRNA水平与NSCLC患者临床特征、疗效关系,绘制生存曲线评价c-myc mRNA表达水平与患者2年无进展生存率关系。结果:肺癌组血清外泌体c-myc mRNA表达水平显著高于良性组、健康组(P<0.001);不同性别、年龄、肿瘤直径、病理类型、分化程度NSCLC患者血清外泌体c-myc mRNA表达水平比较差异无统计学意义(P=0.348、0.448、0.195、0.925、0.078),血清外泌体c-myc mRNA在临床分期Ⅲ期、Ⅳ期者表达水平显著高于Ⅰ期、Ⅱ期者(P<0.001),吸烟者表达水平显著高于非吸烟者(P<0.001);经规范治疗后105例NSCLC患者12例达到完全缓解(CR)、41例部分缓解(PR)、32例稳定(SD)、20例发生疾病进展(PD),且CR、PR、SD、PD四组治疗前、治疗后血清外泌体c-myc mRNA表达水平比较差异均有统计学意义(P<0.001),表现为CR组<PR组<SD组<PD组,且CR、PR组治疗后c-myc mRNA表达水平显著低于治疗前(P=0.034、0.007);血清外泌体c-myc mRNA低表达组2年无进展生存率51.85%,显著高于高表达组的29.49%(P=0.009)。结论:NSCLC患者血清外泌体c-myc mRNA表达水平上升,且与患者临床分期、吸烟有关,检测其表达情况有助于预测患者临床疗效及无进展生存率。

Objective:To explore the expression of serum exosome c-myc mRNA in patients with non-small cell lung cancer(NSCLC), and to analyze its relationship with the prognosis of patients.Methods:A total of 105 NSCLC patients(lung cancer group), 60 benign lung diseases(benign group) and 60 healthy people(healthy group) were selected from January 2017 to March 2019.The serum exosomes were extracted by differential ultracentrifugation, identified by transmission electron microscopy and Western blotting, and the relative expression of PCRc-myc mRNA was detected by real-time fluorescence quantitative detection.The level of c-myc mRNA in serum exosomes was compared among lung cancer group, benign group and healthy group.The relationship between c-myc mRNA level in serum exosomes and clinical characteristics and curative effect of NSCLC patients was analyzed.Survival curve was drawn to evaluate the relationship between c-myc mRNA expression level and 2-year progression-free survival rate.Results:The expression level of serum exosome c-myc mRNA in lung cancer group was significantly higher than that in benign group and healthy group(all P<0.001).There was no significant difference in the expression level of serum exosome c-myc mRNA among NSCLC patients with different genders, ages, tumor diameters, pathological types and differentiation degrees(P=0.348, 0.448, 0.195, 0.925, 0.078).The expression level of serum exosome c-myc mRNA in clinical stages Ⅲ and Ⅳ was significantly higher than that in stages Ⅰ and Ⅱ(P<0.001), and the expression level of smokers was significantly higher than that of non-smokers(P<0.001).After standard treatment of 105 patients with NSCLC, there were 12 cases of complete response(CR), 41 cases of partial response(PR), 32 cases of stable disease(SD) and 20 cases of progression of disease(PD), and there was a significant difference in the expression level of serum exosome c-myc mRNA before and after treatment among the CR, PR, SD and PD groups(all P<0.001), showing CR group <PR group <SD grou P<PD group, and the expression levels of c-myc mRNA in CR and PR groups after treatment were significantly lower than those before treatment(P=0.034, 0.007).The 2-year progression-free survival rate in serum exosome c-myc mRNA low-expression group was significantly higher than that in high-expression group(51.85% vs 29.49%)(P=0.009).Conclusion:The expression level of serum exosome c-myc mRNA is increased among patients with NSCLC, and it is related to the clinical stage and smoking of patients.Detecting the expression level is helpful to predict the clinical efficacy and progression-free survival rate of patients.