Fu X L, Zhu X Z, Shi D R, Xiu L Z, Wang L J, Zhao S, Qian H, Lu H F, Xiang Y B, Jiang G L
Lung Cancer Service, Cancer Hospital, Shanghai Medical University, China.
Lung Cancer. 1999 Feb;23(2):143-52. doi: 10.1016/s0169-5002(99)00009-4.
The outcome of treatment in non-small cell lung cancer (NSCLC) remains poor. One of the reasons is that in many patients its biological behavior does not follow a definite pattern, and can not be accurately predicted prior to treatment. In the present study we have examined the significant prognostic predictors.
One hundred and fifty-eight patients with NSCLC entered this study. They received surgery alone (95 cases) or combined therapy with postoperative irradiation (63 cases). Three types of data have been collected: (1) clinical characteristics: age, sex, Karnofsky performance status, weight loss, T stage, and N stage; (2) histopathology studies: histological types, tumor differentiation, status of vascular and lymphatic vessel invasions; (3) laboratory measurements by immunohistochemistry assay: oncoprotein overexpression, including pan-ras, c-myc, neu, epidermal growth factor receptor (EGFR) and p53, and tumor cell proliferation by proliferating cell nuclear antigen (PCNA).
For the entire group, 5-year actuarial survival, local control and distant metastasis rates were 44, 63 and 40%, respectively. In the univariate analyses, T stage, N stage and lymphatic vessel invasion correlated to survival; T stage and N stage to local control; N stage, lymphatic vessel invasion and pan-ras protein positive stain to distant metastasis. When the index of oncoprotein positive stains was used, the higher index was associated with a higher distant metastasis rate. In the multivariate analyses, T stage, N stage and lymphatic vessel invasion could be independent predictors for survival; T stage for local control; N stage, lymphatic vessel invasion and index of positive oncoprotein stains for distant metastasis.
Late T and N stages, lymphatic vessel invasion and multi-oncoprotein positive stains would predict poor prognoses for NSCLC.
非小细胞肺癌（NSCLC）的治疗效果仍然很差。原因之一是，在许多患者中，其生物学行为没有明确的模式，并且在治疗前无法准确预测。在本研究中，我们研究了重要的预后预测因素。
158例NSCLC患者进入本研究。他们接受单纯手术（95例）或术后放疗联合治疗（63例）。收集了三种类型的数据：（1）临床特征：年龄、性别、卡诺夫斯基功能状态、体重减轻、T分期和N分期；（2）组织病理学研究：组织学类型、肿瘤分化、血管和淋巴管侵犯情况；（3）通过免疫组织化学分析进行的实验室测量：癌蛋白过表达，包括泛ras、c-myc、neu、表皮生长因子受体（EGFR）和p53，以及通过增殖细胞核抗原（PCNA）检测肿瘤细胞增殖。
对于整个组，5年精算生存率、局部控制率和远处转移率分别为44%、63%和40%。在单因素分析中，T分期、N分期和淋巴管侵犯与生存率相关；T分期和N分期与局部控制相关；N分期、淋巴管侵犯和泛ras蛋白阳性染色与远处转移相关。当使用癌蛋白阳性染色指数时，指数越高，远处转移率越高。在多因素分析中，T分期、N分期和淋巴管侵犯可作为生存的独立预测因素；T分期用于局部控制；N分期、淋巴管侵犯和癌蛋白阳性染色指数用于远处转移。
晚期T和N分期、淋巴管侵犯和多种癌蛋白阳性染色可预测NSCLC的预后不良。
