论文部分内容阅读
目的分析Ⅰ~ⅢA期非小细胞肺癌(NSCLC)的切除修复交叉互补组1(ERCC1)表达水平与患者术后生存期的关系,探讨ERCC1表达与患者预后及顺铂耐药的相关性。方法收集1992年2月~1994年1月及2002~2005年经根治性手术并获长期随访的152例Ⅰ-ⅢA期NSCLC患者的临床资料。Ⅰ期NSCLC患者术后随机分成不化疗组和化疗组;Ⅱ、ⅢA期术后均采用以顺铂为主的联合化疗方案。免疫组化法检测所有肿瘤组织标本的ERCC1表达。Kaplan-M eier法计算生存率,Log-rank检验比较差异性,并行Cox模型多因素分析。结果Ⅰ期NSCLC患者ERCC1高表达者,不论化疗与否其预后都明显好于ERCC1低表达者。其中ERCC1高表达组1、3、5年生存率分别为100.00%、91.30%、86.74%,低表达组则为96.43%、60.71%、57.14%(P=0.0058)。不同于Ⅰ期NSCLC,Ⅱ~ⅢA期NSCLC术后化疗患者ERCC1低表达则有较好预后。其中Ⅱ期ERCC1低表达者中位生存期(MST)为60.0+月,而高表达者仅为25.5月(P=0.0442);ⅢA期ERCC1低表达组MST为41个月,高表达组仅为24个月(P=0.0203)。结论ERCC1表达对Ⅰ~ⅢA NSCLC术后患者生存的影响存在双相效应。在Ⅰ期NSCLC中,ERCC1高表达是预后良好的独立指标;而对Ⅱ~ⅢA期NSCLC术后化疗患者,ERCC1高表达更多体现的是对铂类耐药;故采用铂类为基础的辅助化疗可能将无助提高术后长期生存。
Objective To analyze the relationship between the expression of ERCC1 in patients with stage Ⅰ-ⅢA non-small cell lung cancer (NSCLC) and the postoperative survival of patients with NSCLC, and to explore the correlation between the expression of ERCC1 and the prognosis of patients with cisplatin-resistant. Methods The clinical data of 152 patients with stage Ⅰ-ⅢA NSCLC who underwent radical surgery and were followed up from February 1992 to January 1994 and from 2002 to 2005 were collected. Patients with stage I NSCLC were randomly divided into non-chemotherapy group and chemotherapy group. Patients in stage II and IIIA were treated with cisplatin-based combination chemotherapy. The expression of ERCC1 in all tumor tissues was detected by immunohistochemistry. Kaplan-Meier method was used to calculate the survival rate. Log-rank test was used to compare the difference and multivariate Cox model. Results The high expression of ERCC1 in patients with stage Ⅰ NSCLC was significantly better than that in patients with low ERCC1 expression regardless of the prognosis of chemotherapy. The 1, 3, 5-year survival rates of ERCC1 overexpression group were 100.00%, 91.30% and 86.74%, respectively, while those in the low ERCC1 group were 96.43%, 60.71% and 57.14%, respectively (P = 0.0058). Different from stage I NSCLC, low expression of ERCC1 in patients with stage II-IIIA NSCLC has better prognosis. The median survival time (MST) of stage II ERCC1 low expression was 60.0+ months, while the high expression was only 25.5 months (P = 0.0442). The MST of low stage ERCC1 expression in stage IIA was 41 months, 24 months (P = 0.0203). Conclusion There is a biphasic effect of ERCC1 expression on the survival of patients with stage Ⅰ ~ ⅢA NSCLC. In stage Ⅰ NSCLC, high expression of ERCC1 is a good independent prognostic factor; and for stage Ⅱ ~ ⅢA NSCLC patients after chemotherapy, ERCC1 overexpression is more resistant to platinum; so the use of platinum-based adjuvant Chemotherapy may help to improve postoperative long-term survival.