肺腺癌神经内分泌分化与其生物学行为及预后的相关性研究*

目的:探讨肺腺癌的神经内分泌（neuroendocrine，NE）分化的情况及与肺腺癌生物学行为和预后的相关性。方法:收集天津医科大学附属肿瘤医院2005~2006年间，随访资料满3 年的86例肺原发性腺癌患者的病例，术前所有患者均未经化放疗处理。石蜡标本采用EnVision 免疫组织化学二步法检测肺腺癌神经内分泌标记物神经元特异性烯醇化酶（NSE）、嗜铬素A（CgA）及突触素（Syn）的表达，同时采用Kaplan-Meier 曲线描述生存率，并行Log-rank 检验。结果:所有肺腺癌患者中，35例伴有NE分化（占40.7%）。 统计学分析表明，肺腺癌伴NE分化与术后复发及癌细胞分化程度相关；另外，CgA 、NSE 及Syn 的阳性率分别为27.9% 、50.0% 、43.0% ，且Syn 的阳性表达与病理分型、肿瘤分化程度、淋巴结转移、术后复发及3 年生存率相关（P=0.001）。 结论:肺腺癌患者是否伴有NE分化可以作为判断肿瘤转移潜能的指标，而联合检测NSE 及Syn 标记物是判断神经内分泌分化较为可靠的指标，Syn 阳性表达提示患者预后不良。 

Relationship of Neuroendocrine Differentiation in Lung Adenocarcinoma with Its Biological Behavior and Prognosis

Objective: To investigate the correlation of neuroendocdne (NE) differentiation in lung adenocarcinoma with its biological behavior and prognosis.Methods: We reviewed the paraffin-embedded specimens and clinical materials of 86 lung adenocarcinoma cases (45 males and 61 females) seen in our hospital between June 2005 and December 2006.These cases were followed up for 3 years, and none of them underwent radiation or chemotherapy.Immunohistochemical EnVision two-step method was uded to detect the expression of NSE, CgA and Syn proteins.The data were analyzed with SPSS statistics software.Kaplan-Meier survival curve and Log-rank test were constructed.Results: Of the 86 patients with lung adenocarcinoma, 35 cases had NE differentiation simultaneously (40.7%).The statistical analysis showed a significant association between lung adenocarcinoma with NE differentiation and cancer recurrence and histological differentiation.In addition, the positive rate of CgA, NSE and Syn in lung adenocarcinoma was 27.9%, 50.0%, and 43.0%, respectively.The expression of Syn was correlated with pathological type, histological differentiation, lymph node metastasis, postoperative recurrence and 3-year survival rate (P=0.001).Eonclusion: NE differentiation may be an potential metastatic indicator for bi-ological behavior of lung adenocarcinoma.Combined detection of NSE and Syn markers is recommended to detect NE dif-ferentiation in lung adenocarcinoma.Positive expression of Syn indicates poor prognosis.