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目的通过检测肿瘤组织的增殖指数及凋亡指数,探讨Ⅰ期非小细胞肺癌(NSCLC)的细胞增殖、凋亡及其与预后的关系。方法采用免疫组化和脱氧核糖核苷酸末端转移酶介导的缺口末端标记(TUNEL)法检测1994年1月至2002年7月在北京市结核病胸部肿瘤研究所住院接受手术治疗的70例Ⅰ期NSCLC患者肺癌组织的增殖指数(PI)与凋亡指数(AI)。结果肺癌组织的PI较正常肺组织明显上调,与T分期、分化和吸烟有关;肺癌组织的AI较正常肺组织明显上调,与T分期有关;Ⅰ期NSCLC细胞增殖与凋亡无明显相关。高PI组5年存活率较低PI组明显降低,分别为33.57%和73.12%,差异有显著性意义(P=0.0001)。低AI组5年存活率较高AI组明显降低,分别为41.48%和68.80%,差异有显著性意义(P=0.008)。多因素分析结果表明,PI为Ⅰ期NSCLC的独立预后因素(RR=2.473,95%CI:1.278~4.784,P=0.007)。结论Ⅰ期NSCLC为高增殖、高凋亡的亚组,细胞恶性增殖在其发生发展中起重要作用,研究细胞增殖与凋亡有助于判断预后,指导治疗。
Objective To investigate the proliferation and apoptosis of stage Ⅰ non-small cell lung cancer (NSCLC) and its relationship with prognosis by detecting the proliferation index and apoptosis index of tumor tissue. Methods Immunohistochemistry and DNA TdT - mediated nick end labeling (TUNEL) were used to detect 70 cases of hospitalized patients admitted to Beijing Tuberculosis and Thoracic Tumor Institute from January 1994 to July 2002 Proliferation index (PI) and apoptosis index (AI) of lung cancer in patients with stage NSCLC. Results The PI of lung cancer tissues was significantly up-regulated compared with that of normal lung tissues, which was related to T stage, differentiation and smoking. The AI of lung cancer tissues was significantly up-regulated compared with that of normal lung tissues, which was related to T stage. No significant correlation was found between the proliferation and apoptosis of stage Ⅰ NSCLC cells. The 5-year survival rate of high-PI group was significantly lower than that of the lower PI group, which was 33.57% and 73.12%, respectively, with significant difference (P = 0.0001). The 5-year survival rate of low AI group was significantly lower AI group was 41.48% and 68.80%, the difference was significant (P = 0.008). Multivariate analysis showed that PI was an independent prognostic factor for stage I NSCLC (RR = 2.473, 95% CI: 1.278-4.784, P = 0.007). Conclusion Stage Ⅰ NSCLC is a subpopulation with high proliferation and apoptosis. Malignant proliferation of cells plays an important role in the development of NSCLC. Proliferation and apoptosis of cells may be helpful in predicting prognosis and guiding treatment.