肺癌神经内分泌分化与术后生存关系探讨

目的探讨非小细胞肺癌神经内分泌(NSCLC-NE)分化与患者手术后生存关系。方法收集1997年4月-1999年4月98例肺癌手术切除病理标本,采用免疫组化标记特异性烯醇化酶(NSE)及突触素(SY),并按强弱区分为“ 、 、 ”。对同一手术病例标本采用电镜观察特异性NE颗粒。术后病例随访36例,最长60月。采用Cox多因素风险模型分析NSCLC-NE分化与患者术后生存的关系。结果91例为非小细胞肺癌。非小细胞肺癌NE阳性表达率为63.7%(58/91),其中NSE阳性表达54例(59.3%),SY阳性表达22例(24.1%),电镜观察NE特异性颗粒30例(33.0%)。结合免疫组化和电镜观察NSCLC-NE分化44例(48.4%)。Cox模型多因素分析结果表明NSCLC-NE分化者术后生存时间明显缩短(P=0.048)。术后生存与肺癌细胞分化程度(P=0.006)、病理分期(P=0.001)、NE表达强弱(P=0.054)有密切关系。结论NSCLC-NE分化与肿瘤细胞分化和患者术后生存有关。采用NE标志特标记肿瘤,并观察其强弱改变,对术后评估具有较重要的参考意义,可作为临床判断患者预后指标之一。

Prognostic Significance of Neuroendocrine Differentiation inNon-small Cell Lung Cancer Patients' Survival

Objective: To observe the relationship between non-small cell lung cancer with neuroendrocrinedifferentiation (NSCLC-NE) and patients' postoperative survival. Methods: During April 1997 to April1999, 98 cases of lung cancer were surgically treated. The tumor specimens of the patients were stainedby NE markers, i.e. neuron specific enolase (NSE) and synaptophysin (SY). The intensity of NE markersreaction was divided as " ", " ", " " scale groups. The same specimens were also examined under anelectron microscope for the specific neuroendocrine granules. All enrolled patients were followed up for 36months, and the longest follow-up time was 60 months. The COX proportional hazard model multivariateanalysis was applied to observe the relationship between the NSCLE-NE and the patients' postoperativesurvival. Results: In 91 cases of NSCLC, 63.7% (58/91) were positive for NE stain reaction. Amongthem, 59.3% (54/91) were positive for NSE and 24.1% (22/91) for SY. 48.4% (44/91) were consideredas NSCLC-NE by the combination of NE marker stain reaction and electron microscopic examination.COX proportional hazard model multivariate analysis showed that the NSCLC-NE patients' survival wassignificantly shortened (P=0.048). The following factors were related to NSCLC-NE patients' survival:lung cancer cell differentiation (P=0.006), clinical lung cancer stage (P=0.001), the NE markers reaction(P=0.054). Conclusion: NSCLE-NE is significantly related to the cancer cell differentiation and thepatients' postoperative survival. The NE markers should be applied clinically as one of prognostic factorsto evaluate the postoperative survival of NSCLC patients.