目的 探讨Ⅰ期非小细胞肺癌( NSCLC)环氧化酶2(COX-2)、P53、Ki67、EGFR、HER2等基因表达与淋巴结微转移的关系及其预后价值.方法 以S-P免疫组化法检测40例Ⅰ期NSCLC根治术后病灶COX-2、P53、Ki67、EGFR、HER2蛋白表达,以细胞角蛋白为指标检测86枚肺门淋巴结微转移状态.以Kaplan-Meier和Log rank检验进行5年生存资料分析,COX比例风险回归模型进行多因素预后分析.结果 淋巴结微转移检出率16.3％( 14/86)、患者阳性率为12.5％(5/40).肺腺癌COX-2蛋白表达高于肺鳞癌及其他类型肺癌(P＜0.05);其他基因表达在不同的性别、年龄、原发肿瘤大小、组织学分化程度、组织学类型、淋巴结微转移之间差异均无统计学意义(P＞0.05).组织学呈高分化、原发灶COX-2、P53蛋白阴性表达、淋巴结微转移阴性者5年生存率高(分别为78.6％,76.5％,73.7％,60.0％).多因素COX比例风险回归分析显示:组织学分化程度、COX-2、P53蛋白表达是影响Ⅰ期NSCLC的独立预后因素.结论 原发灶组织学分化程度、COX-2、P53蛋白表达是Ⅰ期NSCLC的独立预后因素.%Objective To study the relationship between C0X-2,P53,Ki67,EGFR,HER2 expressions in primary tumor and micrometasta-sis in hilar lymph node and the prognosis for stage I NSCLC. Methods Detecting COX-2, P53, Ki67, EGFR, HER2 protein expressions in primary tumor and cytokeratins expression,as a micrometastasis marker,in 86 hilar lymph nodes of 40 patients with completely resected stage I NSCLC by using S-P irnmunohistochemical staining. Kaplan-Meier method and Log rank test were used to analyze the 5-year survival. Multivariate Cox regression analysis was carried out for the prognosis. Results The positive rate of hilar lymph node micrometastasis was 16.3% (14/86) and 12.5% (5/40) for the positive cases. COX-2 expression in adenocarcinoma was higher than that of squamous and other types of lung cancer (P< 0.05).Other gene expressions were not related to clinical pathologic characteristics such as gender,age,tumor size, differenciation,histologic-tvpe and lymph node micrometastasis(P> 0.05).The 5-year survival rates were higher for patients with well-differ-enciated.negtive expression of COX-2,P53 or those without lymph node micrometastasis(78.57%,76.47%,73.68%,60%). The grade of differentiation and the protein expressions of COX-2, P53 were identified as independent prognostic factors for stage I NSCLC by mun'variate Cox regression analysis. Conclusion The histologic differentiation and the protein expressions of COX-2, P53 in primary tumor were independent prognostic factors for stage I NSCLC.
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