Ⅰ期非小细胞肺癌淋巴结中ck19、肺特异性蛋白X mRNA表达与微转移及预后的相关性研究

摘要

目的 研究Ⅰ期非小细胞肺癌淋巴结中细胞角蛋白19(ck19)、肺特异性蛋白X(LUNX)mRNA表达与转移及预后的相关性.方法 选择68例我院胸外科术后经病理证实为Ⅰ期非小细胞肺癌患者(观察组)和20例确诊为肺炎性假瘤病例(对照组),将入选病例肿瘤组织、肺门旁(N1)、纵隔淋巴结(N2)蜡块,分别做HE染色和免疫组化检测CK19、LUNX mRNA因子表达.结果 68例Ⅰ期非小细胞肺癌患者肿瘤组织均有CK19、LUNX mRNA表达,肺炎性假瘤病例患者淋巴结未见CK19、LUNX mRNA表达.22例淋巴结可见CK19表达,腺癌17例,鳞癌5例;ⅠA期8例,ⅠB期14例.15例淋巴结可见LUNX mRNA表达,腺癌11例,鳞癌4例;ⅠA期5例,ⅠB期10例.腺癌患者淋巴结CK19、LUNX mRNA表达显著高于鳞癌患者,ⅠB期患者淋巴结CK19、LUNX mRNA表达显著高于ⅠA期患者.鳞癌患者与腺癌患者、ⅠB期与ⅠA期患者的N1淋巴结CK19、LUNX mRNA表达差异不明显,鳞癌患者与腺癌患者、ⅠB期与ⅠA期患者的N2淋巴结CK19、LUNX mRNA表达差异显著(P<0.05).仅N1淋巴结表达CK19、LUNX mRN患者的生存时间62.5个月,仅N2淋巴结表达CK19、LUNX mRN患者的生存40.2个月,N1和N2均表达CK19、LUNX mRN患者的生存时间36.6个月,NI和N2均为表达CK19、LUNX mRN患者的生存时间为64.8个月.仅NI表达患者与仅N2表达及N1+N2均表达患者的生存时间差异有统计学意义,与未表达患者的差异不显著.仅N2表达患者的生存时间显著低于未表达患者,与N1和N2均表达患者的生存时间差异不显著.结论 CK19和LUNX mRNA可作为I期非小细胞肺癌患者淋巴结微转移的标记物,腺癌患者和ⅠB期患者淋巴结微转移率更高,N2淋巴结微转移是患者影响I期非小细胞肺癌患者预后的主要原因,N2淋巴结微转移患者的预后更差.%Objective To study the correlation between the expression of cell keratin 19 (CK19), non spe-cific protein X ( LUNX) mRNA expression and prognosis in patients with stage Ⅰ non-small cell lung cancer. Methods 68 cases after thoracic surgery pathologically confirmed as stage Ⅰ non small cell lung cancer patients were se-lected as the observation group, and 20 cases diagnosed as inflammatory pseudotumor as the control group. Their tumor tissue and paraffin block near the door of pulmonary ( N1 ) and mediastinal lymph ( N2 ) were given HE stai-ning and immunohistochemical detection to detect CK19 and LUNX mRNA expression. Results The expression of CK19 and LUNX mRNA was detected in tumor tissues of the observation group, but it wasn't detected in pulmonary inflammatory pseudotumor patients. CK19 expressed in 22 cases of lymph node, 17 cases of adenocarcinoma, 5 cases of squamous cell carcinoma, 8 cases at stage IA, and 14 cases at stage IB. LUNX mRNA expressed in 15 cases of lymph node, 11 cases of adenocarcinoma, 4 cases of squamous cell carcinoma, 5 cases at stage IA, and 10 cases at stage IB. The expression of CK19 and LUNX mRNA was significantly higher in lymph nodes of patients with adeno-carcinoma than in patients with squamous cell carcinoma, and stage IB lymph node higher than stage IA. There was no significant difference in N1 lymph node of CK19 and LUNX mRNA expression between squamous cell carcinoma and adenocarcinoma patients, stage IB and stage IA patients. There were significant differences in N1 lymph node of CK19 and LUNX mRNA expression between squamous cell carcinoma and adenocarcinoma patients, stage IB and stage IA patients (P<0. 05). The survival duration of only N1 lymph node expression of CK19 and LUNX mRNA was 62. 5 months, and 40. 2 months for only N2 lymph node expression of CK19 and LUNX mRNA, and 36. 6 months for N1 and N2 expressed CK19 and Lu Nx mRNA. The survival time of Ni and N2 expression of CK19 and LUNX mRNA was 64. 8 months. Conclusion CK19 and LUNX mRNA can be as markers for stage Ⅰ non small cell lung cancer micrometastasis in lymph nodes of patients, and patients with adenocarcinoma patients at stage IB have higher transfer rate. N2 lymph node micrometastasis is main reason for the prognosis of patients with small cell lung cancer ( NSCLC) and N2 lymph node micrometastasis prognosis is worse.