肺癌的化疗与多药耐药的研究

目的：检测各种类型肺癌化疗前及化疗后复发病例P－gp蛋白的表达情况,探讨其与肺癌多药耐药及患者预后的关系。方法：采用免疫组化染色方法对66例化疗后复发病例及131例未经化疗的肺癌病例进行耐药基因MDR1表达蛋白P－gp检测,结果：化疗后复发病例P－gp阳性表达率明显高于未经化疗的病例（P＜0．05）,其中,癌,小细胞癌化疗后P－gp阳性表达率均明显高于化疗前（P＜0．05）,而肺腺癌则无明显差异（P＞0．05）,未经化疗组不同病理类型的肺癌P-g蛋白阳性表达有显著性差异,从高到低依次为腺癌,鳞癌和小细胞癌（P＜0．05）,化疗后复发组各病理类型肺癌中P－gp蛋白阳性表达率无显著性差异（P＞0．1）,P－gp表达阳性的患者3年生存率明显低于阴性者（P＞0．05）。结论;化疗可能诱导各种病理类型肺癌P-gp蛋白表达增加,肺鳞癌和小细胞肺癌可能为获得性MDR1耐药,肺腺癌是原发性MDR1耐药,肺癌患者P－gp表达程度可作为指导化疗用药及预测预后的指标。

The relationship between chemotherapy and multidrug resistance of lung cancer

Objective To investigate the relationship between multidrug resistance(MDR) and chemotherapy and the possibility of P gp as a clinical prognostic indicator. Methods P gp, MDR1 gene product, was detected in 66 cases of relapsed lung cancer patients after chemotherapy and 131 lung cancer patients with no prior chemotherapy by immunohistochemistry. Results The expressive level of P gp in relapsed group after chemotherapy was much higher than that of non chemotherapy group (P<0.05). A significant difference of P gp expression existed between before and after chemotherapy for squamous cell carcinoma and SCLC (P<0.05), but not for adenocarcinoma. In non chemotherapy group, lung cancer tissues with different histological types had different P gp positive rates, which were adenocarcinoma, squamous cell carcinoma and SCLC in sequence from high to low (P<0.05). In relapsed group after chemotherapy, there was no significant difference among the three types of lung cancer (P>0.05). P gp positive group had a significantly lower 3 year survival rate than negative group (P<0.05). Conclusion Chemotherapy may increase the incident rate of MDR in lung cancer. Adenocarcinoma is mainly primary MDR while SCLC and squamous cell carcinoma are mainly secondary to chemotherapy. P gp expressive level can be used as a common clinical indicator for prognosis and chemotherapy in the patients with lung cancer.