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目的探讨非小细胞肺癌(NSCLC)纵隔淋巴结隐匿性转移的基因诊断方法,并评价其对预后的意义。方法应用实时荧光定量RT-PCR技术,检测46例pN0 NSCLC(Ⅰa～Ⅱb期)的188枚纵隔淋巴结标本中的黏蛋白1(MUC1)mRNA的表达情况。对照组为同期经手术治疗的患者,其中阴性对照淋巴结26枚(取自10例肺良性病变),阳性对照标本26个(10例NSCLC的肿瘤标本)。通过χ2检验,比较预后差别。结果阴性对照组均无MUC1 mRNA表达,特异度100%,表达率为0,阳性对照组26个标本中,24个有MUC1 mRNA表达,灵敏度为92.3%,表达率为(94.6±23.4)%。实验组46例患者的12个标本有MUC1 mRNA表达,占11.2%,其TNM分期上调为Ⅲa。MUC1 mRNA表达阴性组3年生存率(88%)高于MUC1 mRNA阳性组(50%),差异有统计学意义(P<0.05)。结论应用实时荧光定量RT-PCR法检测MUC1 mRNA的表达可诊断肺癌纵隔淋巴结隐匿性转移;纵隔淋巴结隐匿性转移可能与pN0肺癌预后不良有关。
Objective To investigate the gene diagnosis of occult metastasis of mediastinal lymph nodes in non-small cell lung cancer (NSCLC) and to evaluate its significance in prognosis. Methods The expression of MUC1 mRNA in 188 specimens of mediastinal lymph nodes from 46 cases of pN0 NSCLC (stage Ⅰa-Ⅱb) was detected by real-time fluorescence quantitative RT-PCR. The control group consisted of 26 surgically-treated lymph nodes (from 10 benign lung lesions) and 26 positive control specimens (10 specimens of NSCLC). By χ2 test, compare the prognosis. Results There was no MUC1 mRNA expression in the negative control group, with a specificity of 100% and a positive expression rate of 0. MUC1 mRNA was expressed in 24 of 26 specimens of the positive control group with a sensitivity of 92.3% and a positive rate of (94.6 ± 23.4)%. MUC1 mRNA expression was found in 12 of the 46 patients in the experimental group, accounting for 11.2% of the total. The TNM stage was up-regulated to Ⅲa. The 3-year survival rate (88%) of MUC1 mRNA negative group was higher than that of MUC1 mRNA positive group (50%), the difference was statistically significant (P <0.05). Conclusions The detection of MUC1 mRNA by real-time fluorescence quantitative RT-PCR can diagnose the occult metastasis of mediastinal lymph nodes in lung cancer. The occult metastasis of mediastinal lymph nodes may be related to the poor prognosis of pN0 lung cancer.