肺癌淋巴结微转移分子学检测的预后价值

Prognostic value of molecularly diagnosed lymph nodal micrometastasis in lung carcinoma cases

目的 :探讨RT PCR法检测淋巴结肺癌微转移的预后价值 .方法 :同时运用RT PCR法和常规病检法对 4 0例原发性肺癌患者区域性淋巴结 (n =2 6 1 )转移灶进行测定 ,并且分析两种检测结果对术后无瘤生存期的影响 .生存分析用Kaplan Meier法 ,预后分析用COX比例风险模型 .结果 :通过2 6 (4～ 6 0 )mo的中位观察期发现 ,存在淋巴结微转移的患者术后无瘤生存期显著短于无微转移者 (P <0 .0 1 ) .多因素分析显示有无淋巴结微转移 (mN)可作为一项独立的预后因素(P <0 .0 1 ) ,而病检法测定结果 (pN)对预后无显著影响 (P >0 .0 5 ) .结论 :淋巴结微转移灶的存在具有预后提示作用 .

AIM: To evaluate the prognostic significance of molecularly diagnosed lymph nodal micrometastasis in lung carcinoma. METHODS: The metastases in regional lymph nodes ( n =261) of patients with primary lung carcinoma ( n = 40) were detected by both reverse transcriptase polymerase chain reaction (RT PCR) and routine histological examination (HE). The effect on survival was analyzed. The cumulative survival was calculated by the Kaplan Meier method and compared by the log rank test. The prognostic factors were analyzed by the Cox model. RESULTS: Following a median observation time of 26.0 mo (ranging from 4 to 60), patients with lymph nodal micrometastases showed a significantly shorter disease free survival duration than node negative patients (log rank test, P <0.01). The independence of this prognostic significance was demonstrated by a multivariate analysis (Cox regression model, P < 0.01). CONCLUSION: The presence of single lung carcinoma cells in lymph nodes is an independent factor for prognosis. Molecular assessment of micrometastases in lymph nodes is supplementary for current tumor staging in lung carcinoma.