Ⅲ期非小细胞肺癌患者骨髓微转移与新辅助化疗及预后的关系

Relationship between micrometastasis of bone marrow and neoadjuvant chemotherapy and prognosis in patients with stage Ⅲ non-small cell lung cancer

目的 研究Ⅲ期非小细胞肺癌患者骨髓中微转移与新辅助化疗及预后的关系。方法 选取Ⅲ期非小细胞肺癌患者 65例 ,随机分为新辅助化疗组 ( 3 2例 )及直接手术组 ( 3 3例 ) ,两组患者均于术中切取肋骨获得骨髓 ,应用RT PCR技术检测CK19mRNA及CEAmRNA的表达 ,并进一步分析两指标表达情况与生存期的关系。结果 新辅助化疗组及直接手术组患者骨髓中CK19阳性率分别为 18.8% ( 6/ 3 2 )、45 .5 % ( 15 /3 3 ) (P =0 .0 3 3 ) ,CEA阳性率分别为 2 5 .0 % ( 8/ 3 2 )、5 1.5 % ( 17/ 3 3 ) (P =0 .0 41)。CK19与CEA的表达具有正相关关系 (rs=0 .671,P <0 .0 0 1)。CK19及CEA共同阳性者化疗有效率为 0 % ( 0 / 5 ) ,共同阴性者为 5 6.5 % ( 13 / 2 3 ) (P =0 .0 44 )。CK19及CEA共同阳性者及共同阴性者中位生存期分别为 11和 2 7个月 (P =0 .0 0 0 6)。Cox模型分析提示 ,新辅助化疗组中化疗疗效、CK 19及CEA的阳性表达是影响患者预后的独立因素。无效的化疗较有效的化疗死亡风险增加 (P =0 .0 43 ) ,CEA及CK 19阳性表达者较阴性者死亡风险增加 (P =0 .0 2 1,P =0 .0 2 0 )。结论 新辅助化疗能降低Ⅲ期非小细胞肺癌患者骨髓微转移的发生率。骨髓微转移提示患者预后不良。

Objective To investigate the relationship between micrometastasis of bone marrow and neoadjuvant chemotherapy and prognosis in patients with stage Ⅲ non-small cell lung cancer (NSCLC). Methods Sixty-five patients with stage Ⅲ NSCLC were randomly divided into group A (32 patients treated with preoperative neoadjuvant chemotherapy plus operation) and group B (33 patients treated with operation and postoperative chemotherapy as control group). Expression of CK19 mRNA and CEA mRNA was detected in bone marrow samples from the rib segments of all patients obtained from operation by RT-PCR. The relationship between survival duration and CK19 and CEA expression was analyzed. Results The positive rates of CK19 mRNA expression were 18.8%(6/32) and 45.5%(15/33) in group A and B, respectively (P=0.033), and the positive rates of CEA were 25.0%(8/32) and 51.5% (17/33) in group A and B, respectively (P= 0.041). A significant positive correlation was observed between CK19 and CEA expression (r s=0.671,P< 0.001). The response rates of neoadjuvant chemotherapy were 0%(0/5) and 56.5%(13/23) in patients with CK19(+)/CEA(+) and CK19(-)/CEA(-), respectively (P=0.044), and the median survival duration were 11 and 27 months, respectively (P=0.000 6). Cox’s model showed that the response to neoadjuvant chemotherapy and the expression of CK19 or CEA were significantly prognostic factors in group A. Conclusion Neoadjuvant chemotherapy can reduce the possibility of bone marrow micrometastasis in stage Ⅲ NSCLC patients. Bone marrow micrometastasis may indicate a poorer prognosis for NSCLC.