肺癌耐药蛋白在非小细胞肺癌中的表达与临床相关性研究

目的：探讨肺癌耐药蛋白（LRP）在非小细胞肺癌（NSCLC）中的表达与临床相关性。方法：通过纤维支气管镜活检、经皮肺穿刺活检或手术切除而药取肺癌组织标本69例，其中男52例，女17例。I、Ⅱ期28例，Ⅲ、Ⅳ期41例。采用免疫组织化学法进行检测，胞浆呈棕黄色着染为LRP阳性。结果：LRP主要表达于胞浆，69例肺癌组织中，LRP表达阳性39例，男性56％（29／52），女性59％（10／17），总检出率57％（39／69），各年龄段间差异无显著性。肺腺癌中检出率67％（18／27），肺鳞癌中检出率55％（17／31）；T1－2中检出率52％（23／44），T3－4中检出率64％（16／25）；N3中检出率83％（5／6）；在M0中检出率57％（36／63），M1中检出率50%(3/6)。LRP表达与NSCLC中组织类型无相关性（P＞0．05），与原发灶的侵犯范围（T）及转移情况（N、M）无关。LRP阳性组化疗有效率低于LRP阴性组（P＜0．05）。随访中LRP阳性组死亡7例，LRP阴性组死亡3例。结论：在肺腺癌与鳞癌中由LRP引起的耐药发生机率相等；TNM指标只代表肿瘤进展而不代表耐药性差异；LRP在NSCLC中的表达与化疗的有效率及预后有一定的相关性，LRP表达阳性者预后差。有研究报道LRP的表达与多药耐药有关，LRP的检测能指导化疗方案的选择，提高化疗疗效，因此，值得进一步深入研究。

Clinical significance of the expression of lung resistance protein in non-small cell lung carcinomas

OBJECTIVE: To investigate the expression of the lung resistance-related protein (LRP) in non-small cell lung carcinomas (NSCLC) and evaluate its clinical significance. METHODS: Using immunohistochemistry, LRP was examined in 69 NSCLC specimens obtained by either transbronchial biopsy via fibrobronchoscopy or transcutaneous needle biopsy or surgical resection. Of the 69 patients from whom tumor specimens were obtained, 52 were male and 17 were female. RESULTS: LRP expression was detected in 39/69 (57%) tumor specimens. There was no correlation between LRP expression and NSCLC histological classification (P > 0.05). No significant differences were found in gender and among age groups. The positive rates of LRP were 67% (18/27), 55% (17/31), 52% (23/44), 64% (16/25), 83% (5/6), 57% (36/63) and 50% (3/6) in adenocarcinoma, squamous, staging T1-2, T3-4, N3, M0 and M1 respectively. It was shown that LRP expression was not associated with primary tumor size and metastasis status (N,M). NSCLC patients with positive LRP expression responded more poorly to chemotherapy than those with negative LRP expression (P < 0.05). CONCLUSIONS: The frequencies of multidrug resistance caused by LRP are similar between adenocarcinoma and squamous. Expression of LRP is related to multidrug resistance of NSCLC, which in turn related to the efficacy and prognosis of chemotherapy. The examination of LRP expression may be valuable for choice of chemotherapy regimen.