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目的 应用多变量综合判断非小细胞肺癌 (NSCLC)预后及划分高危人群。方法 1 981～ 1 994年间 ,1 5 8例接受手术治疗者进入本研究。其病理切片均被复阅 ,盲法评定病理类型、分化程度、淋巴及血管有无受侵。应用免疫组化法检测Pan ras、c myc、c erbB2、EGFR及p5 3等基因蛋白的表达和增殖细胞核抗原(PCNA) ,Kaplan Meier法计算生存、局控及远处转移率 ,Log Rank法检验差异性。多因素分析采用Cox模型 ,进而计算预后指数PI(prognosticindex) ,并据此划分高危人群。结果 全组患者 5年生存率为 44%。能提示生存差的因子为 :晚期T和N(P =0 .0 2 5和 <0 .0 0 1 ) ,淋巴管受侵 (P <0 .0 0 2 ) ,多个癌基因过度表达 (P =0 .0 1 8)。全组患者的PI中位值为 1 .71 (0 .2 3～ 3 .75 ) ,根据PI值将患者划分成预后好组 (PI≤ 1 .3 ) 42例 ,预后中组 (1 .32 .2 ) 5 3例。三组 5年生存率分别为 77%、45 %和 2 1 % ,有显著性差异 (P <0 .0 0 1 )。结论 能提示可手术NSCLC预后的因子为原发肿瘤大小 (T)、淋巴结转移 (N)、淋巴管受侵和多个癌基因蛋白的过度表达。根据预后方程计算的PI值可用于NSCLC高危人群划分。
Objective To evaluate the prognosis of non-small cell lung cancer (NSCLC) using multivariate comprehensive assessment and identify high-risk groups. Methods From 1981 to 1994, 158 patients who underwent surgical treatment entered the study. The pathological sections were reviewed and blinded to assess the pathological type, differentiation, lymphatic and vascular invasion. Immunohistochemistry was used to detect the expression of Pan ras, c myc, c erbB2, EGFR and p53, and proliferating cell nuclear antigen (PCNA). Kaplan Meier method was used to calculate survival, local control, and distant metastasis rate. difference. Multivariate analysis was performed using the Cox model to calculate the prognostic index (PI) and the high-risk group was divided accordingly. Results The 5-year survival rate of the whole group was 44%. The factors that could indicate poor survival were: late T and N (P =0. 0 2 5 and <0. 0 0 1), lymphatic invasion (P <0. 0 0 2), multiple oncogene overexpression ( P =0.0 1 8). The median PI of the patients in the whole group was 1.71 (0.23 to 3.75). According to the PI value, the patients were divided into 42 cases with good prognosis (PI ≤ 1.3) and the prognosis was moderate (1.3%). 2. 2) 53 cases. The three-year 5-year survival rates were 77%, 45%, and 21%, respectively, with significant differences (P < 0.01). Conclusion The prognostic factors of operable NSCLC are primary tumor size (T), lymph node metastasis (N), lymphatic vessel invasion, and overexpression of multiple oncogene proteins. The PI calculated according to the prognosis equation can be used for the high risk population of NSCLC.