淋巴结隐匿性微转移对肺癌预后影响的临床研究

Clinical Study of Impact of Occult Micrometastasis of Lymph Node on the Prognosis of Patients with Non-small Cell Lung Cancer

目的:诊断肺癌纵隔淋巴结隐匿性微转移并评价其预后意义。方法:应用逆转录聚合酶链反应法(RT-PCR),对58例非小细胞肺癌手术后病理检查阴性(pN0)的242组纵隔淋巴结进行检测,检测淋巴结中MUC1基因mRNA表达,诊断纵隔淋巴结隐匿性微转移。对患者进行随访,应用Kaplan-Meier法计算生存率,Log-Rank检验比较生存差别。结果:16例患者的23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27.6%。患者的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7例,生存率为43.7%,无转移组3年生存31例,生存率为73.8%。两组的生存相比较差异显著(P<0.05)。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pN0患者预后不良有关。

Objective: To diagnose occult micrometastasis of mediastinal lymph node in patients wit h non)small cell lung cancer(NSCLC)and evaluate its clinical prognostic signi ficance. Methods: Two hundred and forty)two stations of mediastinal lymph nodes from fifty)e ight patients with NSCLC without invasion of the tumor confirmed by routine hist opathological examination(pN 0 )were studied to detect mRNA for MUC1gene and determined occult micrometas tasis,by using assays of reverse tran)scriptase)polymerase chain reaction(RT )PCR).The all patients were followed)up for three years.Sur)vival rate was calculated by method of Kaplan)Meier and survival difference between groups wi th and without occult micrometastasis group was compared with Log)Rank test. Results: The mRNA for MUC1gene was identified in twenty)three stations of lymph nod es from sixteen patients,and occult mi)crometastasis was diagnosed in the pati ents(27.6%).TNM staging for those patients was up)regulated from stage I A ～ B to stage A .Seven patients with occult micrometastasis were alive at three year(43 .7%),thirty)one patients without occult micrometastasis were alive at thre e year(73.8%).Three)year survival rate was lower in the former than tha t in the latter(P<0.05). Conclusion: Occult mi)crometastasis in mediasinal lymph node of patients with NSCLC cou ld be diagnosed by identification of MUC1mRNA.Occult micrometastasis of medias inal lymph node in patients with pN 0 disease was an indicator of poorer prognosis.