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目的 预测肺癌手术切除的效果和局部复发情况。方法 应用聚合酶链—单链构象多态分析 (PCR SSCP)方法 ,检测肺癌手术切除标本的无癌支气管切缘和病灶癌组织 p5 3基因突变的情况。 结果 10例支气管切缘有 p5 3基因突变 ,阳性率2 5 .0 %( 10 /40 )。 2 1例病灶癌组织有 p5 3基因突变 ,阳性率 5 2 .5 %( 2 1/40 )。术后全部病例随访 3～ 14个月。在 10例支气管切缘p5 3阳性者中 ,有 4例发生支气管残端癌复发 (复发率 40 .0 %) ,而在 3 0例阴性者中 ,无 1例发生残端癌复发。 2 1例病灶癌组织 p5 3阳性者中 ,有 12例发生癌复发转移 (复发率 5 7.1%) ,19例阴性者中 ,4例发现癌复发转移 (复发率 2 1.1%)。结论 分子学诊断早于临床诊断 3～ 6个月。检测支气管切缘p5 3基因突变 ,能早期预测部分肺癌的术后支气管残端癌复发。病灶癌组织 p5 3阳性者 ,术后癌复发转移率高。
Objective To predict the effect of resection of lung cancer and the local recurrence. Methods The polymerase chain reaction-single strand conformation polymorphism (PCR SSCP) method was used to detect the mutation of p5 3 gene in the tumor-free bronchial margins and cancerous tissues of lung cancer specimens. Results 10 cases of bronchial resection with p5 3 gene mutation, the positive rate of 25.0% (10/40). The mutation of p5 3 gene was found in 21 cases of cancerous tissue, with a positive rate of 52.5% (2 1/40). All cases were followed up for 3 to 14 months. Of the 10 bronchial margins with p53 positive, 4 developed recurrence of bronchial stump carcinoma (40.0% of the recurrence rates), whereas none of the 30 negative cases developed recurrence of stump cancer. Of the 21 cases with p53 positive, 12 cases had recurrence and metastasis (51.1%), while 4 cases found cancer recurrence and metastasis (21.1%) in 19 cases. Conclusion Molecular diagnosis earlier than the clinical diagnosis of 3 to 6 months. Detection of bronchial cut p5 3 gene mutations, early prediction of some lung cancer postoperative bronchial stump cancer recurrence. P53 cancer patients with positive, postoperative recurrence and metastasis rate of cancer.