凋亡抑制蛋白Survivin和Bcl-2在非小细胞肺癌中的表达和意义

目的：探讨凋亡抑制蛋白Survivin和Bcl-2表达与非小细胞肺癌（NSCLC）预后之间的关系.方法：将88例NSCLC及5例正常肺组织标本制作成组织芯片，应用免疫组织化学S—P法检测Survivin和Bcl-2的表达．并与临床病理特征及长期生存进行比较分析.结果：Survivin胞浆和胞核阳性表达率分别为94．3％和79．5％，Bcl-2胞浆和胞核阳性表达率分别为54．5％和42．0％．而正常肺组织均为阴性，Survivin胞浆表达与年龄等临床参数无关．而Survivin胞核在吸烟者中表达升高（P=0．002）,Bcl-2胞浆表达在男性、吸烟者、鳞癌、淋巴结无转移者中升高（P〈0．01）．Bcl-2胞核表达在女性、不吸烟者、腺癌和肿瘤大小为T3和T4者中升高（P〈0．05）Survivin表达与NSCLC病人生存期无关。Bcl-2胞浆表达的病人生存期更长（P=0．005），而Bcl-2胞核表达的病人生存期更短（P=0．012）多因素分析显示Survivin和Bcl-2不是影响NSCLC预后的独立危险因素.结论：Survivin检测可能有助于NSCLC的诊断，Bcl-2胞浆和胞核表达可能具有相反的预后意义.

Prognostic Value of Survivin and Bcl-2 expression in Non-small Cell Lung Cancer: A Tissue Microarray Analysis

Objective:To evaluate the prognostic value of survivin and Bcl-2 in patients with non-small cell lung cancer(NSCLC).Methods:Expression of survivin and Bcl-2 was accessed by immunohistochemical staining on tissue microarray sections,and the results were compared with relevant clinical and pathologic data.Results:Positive rate of cytoplasmic and nuclear survivin in NSCLC was 94.3% and 79.5%,respectively.Positive rate of cytoplasmic and nuclear Bcl-2 in NSCLC was 54.5% and 42.0%,respectively.Neither survivin nor Bcl-2 expression was observed in normal lung tissues.There was no correlation between cytoplasmic survivin expression and clinical characteristics,but nuclear survivin expression was higher in smokers (P=0.002).Cytoplasmic Bcl-2 expression was significantly higher in groups with male,smokers,squamous cell carcinoma and no lymph node involvement (P<0.01),and nuclear Bcl-2 expression was significantly higher in groups with male,non-smokers,adenocarcinoma and tumor size with T3 and T4 (P<0.05).However,survivin expression was not related with survival.Patients with positive expression of nuclear Bcl-2 had worse overall survival (P=0.012),whereas positive expression of cytoplasmic Bcl-2 predicted better overall survival (P=0.005).Multivariate analysis using Cox regression modal showed that neither survivin nor Bcl-2 was the important independent prognostic factor for survival.Conclusions:These results indicate that survivin highly expresses in NSCLC,so the ubiquitous expression makes it a potential noval parameter for diagnosis,and cytoplasmic and nuclear expression of Bcl-2 might possess completely opposite prognostic significance in patients with NSCLC.