原发性非小细胞肺癌中PCNA及survivin的表达及临床意义

目的探讨非小细胞肺癌（Non—small cell lung cancer，NSCLC）中增殖细胞核抗体（Proliferating Cell Nuclear Antigen，PCNA）及凋亡抑制基因survivin的表达对患者预后的影响。方法采用免疫组织化学SP法，检测92例非小细胞肺癌组织中PCNA基因及survivin基因的表达，分析PCNA及survivin的表达与非小细胞肺癌临床病理特征之间的关系及其与患者预后的关系。结果92例非小细胞肺癌中PCNA阳性表达率为60．9（56／92），其表达与肿瘤大小、组织学类型、有无淋巴。结转移、临床病理分期等无关，而与NSCLC的组织学分级及原发肿瘤T分期有关，在组织学分级为Ⅲ级的肿瘤中的表达明显高于Ⅰ＋Ⅱ级的肿瘤中的表达，差异有统计学意义（66．7％vs52．6％，x^2=4．269，P=0．039）；在T3＋T4期中的阳性表达率明显高于在T1＋T2期中的表达率，差异有统计学意义（75．8％vs52．5％，x^2=4．789，P=0．029）。survivin阳性表达率为46．7％（43／92），其表达与肿瘤大小、有无淋巴结转移、临床病理分期以及组织学类型等无关，而与NSCLC的组织学分级有关，在组织学分级为Ⅲ级的肿瘤中的表达明显高于Ⅰ＋Ⅱ级的肿瘤组织中的表达，差异有统计学意义（52．1％vs37．5％，x^2=3．975，P=0．046）。单因素生存分析显示PCNA阳性组及survivin阳性组的总生存时间均低于PCNA阴性组及survivin阴性组，差异有统计学意义（P=0．025及0．033）。结论PCNA和survivin表达是NSCLC患者预后不良因素之一，联合检测PCNA和survivin并结合临床病理分期、组织学分级可以更准确地评价非小细胞肺癌患者的预后。

Expression and clinical significance of PCNA and survivin in non-small cell lung cancer

Objective To investigate the expression of proliferating cell nuclear antigen（PCNA）and survivin gene in non-small cell lung cancer （NSCLC） and its influence on prognosis of patients with NSCLC. Methods The expression of PCNA and survivin in 92 specimens of patients with NSCLC was detected by SP immunohistochemistry. Its correlation to clinicopathologic features and prognosis of patients with NSCLC were analyzed. Results The positive rate of PCNA was 60.9% （56/92） in non-small cell lung cancer tissues. The expression of PCNA had no correlation to histological type, lymph node metastasis and TNM stage （P〉0.05） , but was correlated to histological grade and tumor size of NSCLC. The positive rate of PCNA in NSCLC of grade m was significantly higher than that in NSCLC of grade Ⅰ and grade Ⅱ （66.7% vs 52.6%, x^2=4.269, P=-0.039） ; The positive rate of PCNA in tumor size of T3＋T4 was significantly higher than that in tumor size of T3＋T4 （75.8% vs 52.5%, x^2=4.789, P= 0.029） . The positive rate of survivin was 46.7 % （43/92） in non-small cell lung cancer tissues. The expression of survivin had no correlation to tumor size, lymph node metastasis and TNM stage, but was correlated to histological type and histological grade of NSCLC. The positive rate of survivin in NSCLC of grade Ⅲ was significantly higher than that in NSCLC of grade Ⅰ and grade Ⅱ （52.1% vs 37.5%, x^2=3.975,P=0.046）. Univariate analysis showed that the overall survival rate in PCNA-positive or survivin-positive cases was significantly shorter than that in PCNA-negative or survivin-negative cases （P=0.025 and 0.033）. Conclusion The expression of PCNA and survivin may indicate poor prognosis of NSCLC. Detecting PCNA and survivin with consideration of clinicopathological stage and histological grade may increase the accuracy of predicting prognosis of patients with NSCLC.