van Bodegom P C, Baak J P, Stroet-van Galen C, Schipper N W, Wisse-Brekelmans E C, Vanderschueren R G, Wagenaar S S
Department of Pathology, Free University Hospital, Amsterdam, The Netherlands.
Cancer. 1989 Jan 1;63(1):143-7. doi: 10.1002/1097-0142(19890101)63:1<143::aid-cncr2820630123>3.0.co;2-x.
Previous studies have shown that ploidy is an important prognostic determinant in lung cancer, but in those studies followup was restricted to three years, while patients with Stage 1, 2 and 3 disease and with different histological subtypes were included. Theoretically, these factors could have influenced the findings, especially since aneuploidy strongly correlated with the stage of disease. Because of this, tumor ploidy was studied in surgically resected stage 1 (T1/2, N0M0) squamous cell lung cancer patients with a minimal followup of 6 years. All patients were accurately staged by mediastinal lymph node mapping. Fifty-two from a group of 1539 patients with lung cancer diagnosed between 1980 and 1986 inclusive, fulfilled these criteria. Of these tumors, 23 (44%) were diploid with a 6-year survival of 53% and 29 (56%) were aneuploid with a 6-year survival of 48%. Although diploidy tended to be associated with local relapse of the tumor and aneuploidy with distant metastases, the difference was not significant and neither showed a survival advantage. However, within the aneuploid tumors, there was a significant correlation between the percentage of aneuploid cells and survival, defined as event-free or time to death. Seventeen patients with a percentage of more than 10 had a worse outcome (12 died, 6 years survival 35%), than to the other 12 patients with less than 10% aneuploid cells (2 died, 6-year survival 78%) (Mantel-Cox = 6.04, P = 0.01). This implies that in patients with accurately staged and histologically proven Stage 1 squamous cell lung cancer and long-term follow up, DNA content classified as diploid and aneuploid is not a prognostic factor for survival, but the percentage of aneuploid tumor cells is correlated with the prognosis.
既往研究表明，倍性是肺癌重要的预后决定因素，但在这些研究中，随访时间限制在三年，且纳入了Ⅰ、Ⅱ、Ⅲ期疾病以及不同组织学亚型的患者。从理论上讲，这些因素可能影响研究结果，尤其是因为非整倍体与疾病分期密切相关。因此，我们对手术切除的Ⅰ期（T1/2，N0M0）肺鳞状细胞癌患者的肿瘤倍性进行了研究，这些患者的最短随访时间为6年。所有患者均通过纵隔淋巴结图谱进行准确分期。在1980年至1986年（含）期间诊断的1539例肺癌患者中，有52例符合这些标准。在这些肿瘤中，23例（44%）为二倍体，6年生存率为53%；29例（56%）为非整倍体，6年生存率为48%。虽然二倍体往往与肿瘤局部复发相关，非整倍体与远处转移相关，但差异无统计学意义，二者均未显示出生存优势。然而，在非整倍体肿瘤中，非整倍体细胞百分比与生存（定义为无事件生存或至死亡时间）之间存在显著相关性。17例非整倍体细胞百分比超过10%的患者预后较差（12例死亡，6年生存率35%），而另外12例非整倍体细胞百分比低于10%的患者（2例死亡，6年生存率78%）预后较好（Mantel-Cox = 6.04，P = 0.01）。这表明，在分期准确且经组织学证实为Ⅰ期的肺鳞状细胞癌患者并进行长期随访时，DNA含量分类为二倍体和非整倍体并非生存的预后因素，但非整倍体肿瘤细胞百分比与预后相关。
