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背景与目的ⅢA期非小细胞肺癌(non-smallcelllungcancer,NSCLC)新辅助化疗作用仍存在争议,多种基因表达虽然存在一定预后意义,但对预测ⅢA期NSCLC新辅助化疗作用仍未明了。本研究拟探讨多种基因表达对可手术ⅢA期NSCLC新辅助化疗疗效的预测作用。方法在对比ⅢA期NSCLC新辅助化疗与单纯手术疗效的前瞻性随机对照研究中,同期采用免疫组化法,检测抑癌基因p53,癌基因K-ras、HER2,血管内皮生长因子(vascularendothelialgrowthfactor,VEGF),表皮生长因子受体(epidermalgrowthfactorreceptor,EGFR),粘连因子CD44,金属蛋白酶-9(matrixmetalloproteinase-9,MMP-9)等蛋白表达。结果新辅助化疗组与单纯手术组的高基因表达率为58.3%比40.6%(P=0.145)。在新辅助化疗患者,组织学病理缓解有效与无效组两年无病生存率及生存期均无显著性差异(P=0.903,P=0.238);高基因表达与病理有效率亦无相关性(P=0.862);高基因与低基因表达组患者的平均无疾病生存分别为(14.1±9.8)月和(27.2±13.6)月(P=0.032),两年无疾病生存率分别为38.1%比46.7%(P=0.607),两组生存曲线出现明显分离,(P=0.093)。结论新辅助化疗患者的高基因表达预示术后更易发生远处转移,对这些患者是否术后加用化疗仍需进一步研究。
BACKGROUND & OBJECTIVE: The role of neoadjuvant chemotherapy in stage A non-small cell lung cancer (NSCLC) remains controversial. Although there are some prognostic significance for the expression of multiple genes, the role of neoadjuvant chemotherapy in predicting stage IIIA NSCLC remains unclear. This study was to investigate the predictive value of multiple gene expressions on the efficacy of neoadjuvant chemotherapy for stage ⅢA NSCLC. Methods In a prospective randomized controlled trial comparing the efficacy of neoadjuvant chemotherapy with surgery alone in stage Ⅲ A NSCLC, immunohistochemistry was used to detect the expression of tumor suppressor gene p53, oncogene K-ras, HER2, vascularendothelial growth factor (VEGF) ), Epidermal growth factor receptor (EGFR), adhesion molecule CD44, matrix metalloproteinase-9 (MMP-9) and other proteins. Results The high gene expression rates of the neoadjuvant chemotherapy group and the simple operation group were 58.3% and 40.6%, respectively (P = 0.145). There was no significant difference in the two-year disease-free survival and survival between patients with neoadjuvant chemotherapy and those with effective histopathology (P = 0.903, P = 0.238). There was no correlation between high gene expression and pathologic efficiency P = 0.862). The mean disease-free survival of patients with high and low gene expression was (14.1 ± 9.8) months and (27.2 ± 13.6) months respectively (P = 0.032). The two-year disease-free survival rates were 38.1% 46.7% (P = 0.607). There was a significant difference between the two groups (P = 0.093). Conclusion The high gene expression in patients with neoadjuvant chemotherapy predicts more distant metastasis after surgery. Whether these patients need chemotherapy or not after chemotherapy remains to be further studied.