淋巴结隐匿性微转移对肺癌预后影响的前瞻性研究

Impact of occult micrometastasis of lymph node on the prognosis of patients with non-small cell lung cancer: a prospective study

目的 探讨肺癌纵隔淋巴结隐匿性微转移的诊断方法并评价其预后意义。方法 应用逆转录聚合酶链反应法 (RT PCR) ,对 5 8例非小细胞肺癌手术后病理检查阴性 (pN0 )的 2 4 2组纵隔淋巴结进行淋巴结中MUC1基因mRNA表达的再检测 ,诊断纵隔淋巴结隐匿性微转移。对病人进行随访 ,应用Ka plan Meier法计算生存率 ,Log Rank检验比较生存差别。 结果 16例病人的 2 3组纵隔淋巴结中检测到MUC1基因mRNA表达 ,诊断为纵隔淋巴结隐匿性微转移 ,常规病理检查的漏诊率为 2 7 6 % (16 /5 8例 )。病人的TNM分期由IA～IIB 期上调为IIIA 期。纵隔淋巴结隐匿性微转移组 3年生存率为 4 3 7% ,无转移组的 3年生存率为 73 8%。两组差异有显著统计学意义 (P <0 0 5 )。结论 应用RT PCR法检测纵隔淋巴结中MUC1基因mRNA的表达 ,可以诊断纵隔淋巴结隐匿性微转移 ,提高肺癌TNM分期的准确性 ;纵隔淋巴结隐匿性微转移与部分pN0 病人预后不良有关。

Objective: To diagnose occult micrometastasis of mediastinal lymph node in patients with non small cell lung cancer (NSCLC) and to evaluate its prognostic significance. Methods: Using assays of reverse transcriptase polymerase chain reaction (RT PCR), two hundred and forty two stations of mediastinal lymph node, which were free from tumor determined by routine histopathological examination (pN 0), from fifty eight patients were studied to detect mRNA for MUC1 gene and diagnose nodal occult micrometastasis. Survival rate was calculated by method of Kaplan Meier and survival difference between patients with and without nodal occult micrometastasis was compared with Log Rank test; Logistic regression analysis was carried to determined independent predictive factors of prognosis. Results: The mRNA for MUC1 gene was identified in twenty three stations of lymph node from sixteen patients (27 6%), and nodal occult micrometastasis was diagnosed in those patients. TNM staging for those patients was up regulated from stage I A～II B to stage III A. The survival rate of 3 year in patients with nodal occult micrometastasis (43.7%) was lower than that in patients without nodal occult micrometastasis (73.8%) (P<0.05). Logistic multivariate regression analyses revealed that nodal occult micrometastasis was independent prognostic adverse factors (P<0.05). Conclusion: Occult micrometastasis in mediastinal lymph node of patients with NSCLC could be diagnosed by identification of MUC1 mRNA. Occult micrometastasis of mediastinal lymph node may be related to poor prognosis in some pN 0 disease patients.