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目的 检测肺癌组织和支气管切缘p5 3基因突变 ,以预测肺癌手术切除的效果和局部复发。方法 用PCR SSCP方法 ,检测 5 0例肺癌和 7例肺部良性疾病手术切除标本的支气管切缘 (切缘病理无癌残留 )、病灶组织和正常肺组织中的p5 3基因突变 ,并随访了解术后切缘癌复发与癌复发转移情况。结果 14例 ( 2 8% )肺癌支气管切缘和 2 8例 ( 5 6% )肺癌组织存在p5 3基因突变 ,正常肺组织和良性病变肺组织未发现p5 3基因突变。肺癌组织p5 3基因突变以小细胞癌 ( 10 0 % )最高 ,次为鳞癌 ( 65 % ) ,腺鳞癌 ( 60 % ) ,腺癌 ( 3 8.9% )。p5 3基因突变以TNM分期的Ⅲ期 ( 72 .7% )最高 ,次为Ⅱ期 ( 5 8.3 % ) ,Ⅰ期( 2 5 % )。支气管切缘p5 3阳性者术后随访 3～ 16月 ,6例 ( 4 2 .9% )发生支气管残端癌复发 ;而p5 3阴性者术后无残端癌复发。肺癌组织p5 3阳性者中有 17例 ( 60 .7% )在随访中发现癌复发转移 ;p5 3阴性者中 5例 ( 2 2 .7% )发现癌复发转移 ,两组复发率有显著差异 (P <0 .0 5 )。结论 检测支气管切缘p5 3基因突变能确诊支气管切缘异常的“分子边界” ,从而早期预测部分肺癌的术后残端癌复发。肺癌组织p5 3基因突变者术后癌复发转移率高
Objective To detect the mutation of p5 3 gene in lung cancer tissues and bronchial margins to predict the surgical resection and local recurrence of lung cancer. Methods The PCR-SSCP method was used to detect the mutation of p5 3 gene in bronchial margins (no margins of the margins pathology), lesions and normal lung tissues of 50 lung cancer patients and 7 patients with benign lung diseases. Follow-up Recurrence and recurrence and metastasis of cancer after operation. Results The mutation of p5 3 gene was found in 14 cases (28%) of lung cancer and 28 cases of lung cancer (56%). No mutation of p5 3 gene was detected in normal lung tissues and benign lung tissues. The mutation of p5 3 gene in lung cancer was the highest in small cell carcinoma (10 0%), followed by squamous cell carcinoma (65%), adenosquamous carcinoma (60%) and adenocarcinoma (3 8.9%). The stage Ⅲ (72.7%) TNM staging was the highest in p5 3 gene mutation, with stage Ⅱ (5 8.3%) and stage Ⅰ (25%). Bronchoscopic resection of p5 3 positive patients were followed up for 3 to 16 months, 6 cases (42.9%) of the recurrence of bronchial stump cancer; and p5 3 negative patients without recurrence of stump cancer. Seventeen (60.7%) of the p53-positive lung cancer patients were found to have recurrence and metastasis at follow-up. Five patients (22.7%) were found to have recurrence and metastasis, and the recurrence rate was significantly different between the two groups (P <0. 05). Conclusion Detecting the mutation of p5 3 gene in bronchial margin can diagnose the “molecular boundary” of abnormal bronchial margin and predict the recurrence of stump cancer in some lung cancer early. The mutation of p5 3 gene in lung cancer has a high recurrence and metastasis rate after operation