论文部分内容阅读
背景与目的最新的研究发现Ⅰ期非小细胞肺癌(NSCLC)术后辅助化疗可提高患者生存率,因此通过预后分层筛选高危患者给予辅助治疗,既可改善Ⅰ期NSCLC患者的整体预后,又可避免因过度治疗对低危患者造成损害,是目前临床急需解决的问题。本研究旨在探讨肿瘤血管生成和血管浸润(BVI)对Ⅰ期NSCLC预后的影响,建立Ⅰ期NSCLC预后模型。方法回顾性分析118例Ⅰ期NSCLC手术患者的临床病理资料,免疫组织化学检测血管内皮生长因子(VEGF)的表达水平,计算肿瘤内微血管密度(MVD)。以CD34标记的血管腔内瘤细胞的存在判定为BVI。结果肺癌组织VEGF低表达44例(37.3%),高表达74例(62.7%)。VEGF高表达组MVD显著高于低表达组(33.4±17.8vs24.7±14.8,P=0.010),VEGF与MVD间存在正相关(r=0.216,P=0.019)。VEGF高表达患者5年生存率显著低于低表达者(36.48% vs 72.20%,P=0.003)。无BVI者86例(72.9%),BVI者32例(27.1%),后者5年生存率显著低于前者(34.38% vs 60.47%,P=0.018)。多因素分析结果表明VEGF高表达(RR=2.96,P=0.001)和BVI(RR=1.95,P=0.020)为Ⅰ期NSCLC的独立预后因素。进一步根据VEGF表达及BVI情况,将患者分为低度危险组:VEGF低表达+BVI(-);中度危险组:VEGF高表达或BVI(+);高度危险组:VEGF高表达+BVI(+)。三组间5年生存率差异有统计学意义(72.28% vs 52.63% vs 28.00%,P=0.001)。结论VEGF表达与BVI的联合检测可能实现对Ⅰ期NSCLC进行预后分层,为术后患者的个性化治疗提供依据。
BACKGROUND & OBJECTIVE: Recent studies have found that postoperative adjuvant chemotherapy for stage I non-small cell lung cancer (NSCLC) can improve patient survival. Therefore, stratified screening of high-risk patients with adjuvant therapy by stratified prognosis may improve the overall prognosis of patients with stage I NSCLC. To avoid over-treatment of low-risk patients cause damage, is currently an urgent need to solve clinical problems. This study aimed to investigate the effects of tumor angiogenesis and vascular infiltration (BVI) on the prognosis of stage I NSCLC, and to establish a prognosis model of stage I NSCLC. Methods The clinical and pathological data of 118 patients with stage Ⅰ NSCLC were retrospectively analyzed. The expression of vascular endothelial growth factor (VEGF) was detected by immunohistochemistry, and the intracranial microvessel density (MVD) was calculated. The presence of CD34-labeled intravascular luminal cells was judged as BVI. Results Low expression of VEGF in lung cancer tissues was observed in 44 cases (37.3%) and high expression in 74 cases (62.7%). MVD in high VEGF expression group was significantly higher than that in low expression group (33.4 ± 17.8vs24.7 ± 14.8, P = 0.010). There was a positive correlation between VEGF and MVD (r = 0.216, P = 0.019). The 5-year survival rate of patients with high VEGF expression was significantly lower than those with low expression (36.48% vs 72.20%, P = 0.003). There were 86 cases (72.9%) without BVI and 32 cases (27.1%) with BVI, the latter 5 years survival rate was significantly lower than the former (34.38% vs 60.47%, P = 0.018). Multivariate analysis showed that the high expression of VEGF (RR = 2.96, P = 0.001) and BVI (RR = 1.95, P = 0.020) were independent prognostic factors for stage I NSCLC. According to the expression of VEGF and BVI, the patients were divided into low risk group: VEGF low expression + BVI (-); moderate risk group: VEGF high expression or BVI (+); high risk group: VEGF high expression + BVI +). The 5-year survival rates of the three groups were significantly different (72.28% vs 52.63% vs 28.00%, P = 0.001). Conclusion The combined detection of VEGF expression and BVI may achieve the prognosis stratification of stage Ⅰ NSCLC and provide the basis for the personalized treatment of postoperative patients.