术前PC方案对肺癌基因Bcl-2和Beclin-1表达的影响及与患者预后的关系

目的:探讨Bcl-2和Beclin-1基因在Ⅲa期肺腺癌中的表达与术前PC化疗方案之间的关系及其对患者预后的影响。方法:通过免疫组化检测40例Ⅲa期肺腺癌患者Bcl-2和Beclin-1蛋白表达水平。利用real-time PCR法检测术前PC方案化疗对Bcl-2和Beclin-1基因表达水平影响。通过回归分析研究Bcl-2和Beclin-1基因表达水平与PC方案化疗对患者预后的影响。结果:Bcl-2和Beclin-1蛋白表达水平仅与肿瘤分化有关(P=0.027)；Bcl-2和Beclin-1蛋白表达呈负相关(r=-0.48,P＜0.001)。经过PC方案化疗后，Bcl-2表达水平下降， Beclin-1表达水平增高(P＜0.05)。单因素分析显示患者DFS时间与区域淋巴结转移(P=0.025)、肿瘤分化(P＜0.001)、Bcl-2表达水平(P＜0.001)、Bcline-1表达水平(P=0.038)之间具有统计学意义。多因素分析表明DFS只与肿瘤的分化程度有关(P=0.013)，而与Bcl-2和Bcline-1及淋巴结转移情况无关(P＜0.05)。对于Ⅲa期N2型肺腺癌患者中的Bcl-2(+)Beclin-1(-)患者术前PC方案能显著影响Bcl-2的表达从而影响患者的DFS时间(P＜0.05)。结论:利用新辅助PC方案术前化疗可以影响肺腺癌组织中Bcl-2和Beclin-1的表达水平，促进肿瘤细胞凋亡，影响患者DFS生存时间。

The effect of preoperative chemotherapy of PC regimen on the expression of Bcl - 2 and Beclin - 1 and the prognosis for the patients with lung cancer

Objective:To investigate the association between neoadjuvant chemotherapy PC regimen and the ex-pression of Bcl - 2 and Beclin - 1 and to explore its effect on the survival for the patients with stage IIIa lung adeno-carcinoma. Methods:Immunohistochemistry was used to detect the protein expression of Bcl - 2 and Beclin - 1 in 40 patients with stage IIIa lung adenocarcinoma. The real - time PCR was used to evaluate the effect of PC regimen on the mRNA expression of Bcl - 2 and Beclin - 1. Regression analysis was performed to estimate the effect of Bcl - 2 and Beclin - 1 expression and PC regimen chemotherapy on the disease - free survival. Results:The protein expression level of Bcl - 2 and Beclin - 1 significantly associated with tumor grade(P = 0. 027). The protein expression level of Bcl - 2 inversely correlated with that of Beclin - 1(r = - 0. 48,P ﹤ 0. 001). The mRNA expression level of antiapop-totic gene Bcl - 2 after chemotherapy was lower than that before chemotherapy with PC regimen. However,the mRNA expression level of autophagy gene Beclin - 1 was higher(P ﹤ 0. 05). Univariable regression analysis showed that dis-ease - free survival significantly associated with lymph node metastasis(P = 0. 025),tumor grade(P ﹤ 0. 001),Bcl -2 expression level(P ﹤ 0. 001)and Beclin - 1 expression level(P = 0. 038). And the multivariable regression analysis showed that disease - free survival significantly associated with tumor grade(P = 0. 013),but not with Bcl - 2 expres-sion level,Beclin - 1 expression level or lymph node metastasis(P ﹥ 0. 05). The survival analysis displayed that neo-adjuvant chemotherapy PC regimen significantly associated with the expression of Bcl - 2 and disease - free survival for the lung adenocarcinoma. patients with stage IIIa subtype N2,Bcl - 2( + )and Beclin - 1( - )(P ﹤ 0. 05). Con-clusion:Neoadjuvant chemotherapy with PC regimen could influence the expression of Bcl - 2 and Beclin - 1 and the disease - free survival for the patients with lung adenocarcinoma,promote the apoptosis of tumor cells.