65例小细胞肺癌纤支镜病理活检标本的免疫组化分析及临床意义

目的 研究小细胞肺癌(SCLC)纤支镜病理活检标本免疫组化。 方法 选取2014年1月-2017年1月于杭州师范大学附属医院诊治的65例确诊为SCLC的患者作为研究对象。分析SCLC临床病理及免疫组化的结果。 结果 65例SCLC患者中,男性患者42例,女性患者23例,年龄为(57.1±2.6)岁。既往有吸烟史患者45例,男性比例显著高于女性(P<0.05);在不同性别患者中其肿瘤组织分型、年龄、肿瘤发生部位、肿瘤组织分期等差异无统计学意义(均P>0.05);SCLC患者CD56、TTF-1、CK、Syn的阳性率分别为90.77%(59/65)、81.53%(53/65)、69.23%(45/65)、73.8%(48/65),Ki-67指数 ≥ 60%者50例,占76.9%。其中,在局限期SCLC中,Ki-67指数 ≥ 60%者16例,占局限期患者总数的51.6%;在广泛期SCLC中,Ki-67指数 ≥ 60%者28例,占广泛期患者总数的82.35%;广泛期所占比例显著高于局限期,P<0.05。其余SCLC患者在肿瘤发生部位、组织分型和分期比较,差异无统计学意义(均P>0.05)。 结论 吸烟是诱发肺癌的主要危险因素之一,且该病患者肿瘤组织分期多以广泛期为主,TTF-1、CK、CD56、Ki-67、Syn等指标免疫组化指标检测是确诊SCLC的重要手段与方法之一。大部分SCLC患者的免疫组化Ki-67指数 ≥ 60%,且主要集中于广泛期患者中,因此,可以将患者的免疫组化Ki-67指数是否大于60%作为SCLC患者肿瘤分期及临床诊疗评估、预后预测的重要参考,建议推广实施。 

Clinical analysis on the immunohistochemical characteristics of the pathological biopsy specimen in 65 SCLC patients

Objective To study the immunohistochemical characteristics of the bronchofiberscope-guided pathological biopsy specimen in small cell lung cancer (SCLC) patients. Methods A total of 65 SCLC patients confirmed from January, 2014 to January, 2017 in our hospital were selected. The clinical pathological results and immunohistochemical characteristics were analyzed. Results The SCLC occurred in 42 male cases and 23 female cases, respectively. The age was (57.1±2.6) years old. 45 cases had the smoking history. The male ratio was significantly higher than that of female ratio (P<0.05); the histological types, age, positions of tumor and pathological staging for the different genders of patients were not significantly different (P>0.05). The positive rate of CD56, TTF-1, CK and Syn in the SCLC patients was 90.77% (59/65), 81.53% (53/65), 69.23% (45/65) and 73.8% (48/65), respectively. The patient's ratio with Ki-67 index ≥ 60% was 76.9% (50 cases). The patient's ratio with Ki-67 index ≥ 60% was 51.6% (16 cases) at the limited stage and 82.35%(28 cases) at the extensive stage. The related percentage at the limited stage was significantly higher than that at the extensive stage (P<0.05); the positions of tumor, histological types and pathological staging in the other phenotypes of SCLC patients were not significantly different (P>0.05). Conclusion Smoking is one of the major risk factors of SCLC that is majorly occurred at the extensive stage. The immunohistochemical index of TTF-1, CK, CD56, Ki-67 and Syn are of great importance to the final diagnosis of SCLC. The majority of the SCLC patients have the Ki-67 index ≥ 60%, that are majorly occurred at the extensive stage. Therefore, the Ki-67 index ≥ 60% can be considered as the important prediction indicators on the clinical assessment and prognosis of SCLC. It shall be recommended in clinical practice.