Twist、Snail 和 E-cadherin 表达在病理 N0 非小细胞肺癌中的预后价值：一项回顾性队列研究。
Prognostic value of Twist, Snail and E-cadherin expression in pathological N0 non-small-cell lung cancer: a retrospective cohort study.
机构信息
Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.
Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.
出版信息
Eur J Cardiothorac Surg. 2018 Aug 1;54(2):237-245. doi: 10.1093/ejcts/ezy022.
OBJECTIVES
Lung cancer is the leading cause of cancer-related death worldwide. The 5-year survival rate for patients after curative surgery with pathological N0 non-small-cell lung cancer (NSCLC) is as low as 56%, which is due to recurrence and metastasis. Emerging evidence suggests that epithelial-mesenchymal transition is important for cancer metastasis. Twist and Snail are epithelial-mesenchymal transition regulators that induce metastasis by down-regulating E-cadherin. The aim of this study was to evaluate the prognostic value of Twist, Snail and E-cadherin expression in patients with resectable pathological N0 NSCLC.
METHODS
The expression levels of Twist, Snail and E-cadherin in 78 patients with resected pathological N0 NSCLC were assessed using immunohistochemistry. The association between the expression of Twist/Snail/E-cadherin and overall survival (OS) and recurrence-free survival (RFS) was investigated.
RESULTS
High expression of Twist, Snail and E-cadherin was detected in 18%, 21% and 53% of NSCLC samples, respectively. High expression of Twist and Snail and low expression of E-cadherin were associated with worse RFS [hazard ratio (HR) 2.29, 95% confidence interval (CI) 1.07-4.87, P = 0.026; HR 2.54, 95% CI 1.24-5.20, P = 0.008 and HR 2.41, 95% CI 1.23-4.73, P = 0.007, respectively] and worse OS (HR 2.26, 95% CI 1.01-5.04, P = 0.040; HR 2.56, 95% CI 1.20-5.43, P = 0.011 and HR 2.42, 95% CI 1.18-4.95, P = 0.012, respectively). Co-expression of at least 2 markers from the combination of high Twist/high Snail/low E-cadherin expression predicted poor RFS and OS (HR 4.12, 95% CI 2.08-8.16, P < 0.001 and HR 4.28, 95% CI 2.08-8.77, P < 0.001, respectively), and it was an independent predictor of RFS and OS (HR 3.99, 95% CI 1.89-8.44, P < 0.001 and HR 4.16, 95% CI 1.88-9.18, P < 0.001, respectively).
CONCLUSIONS
Co-expression of at least 2 markers from the combination of high Twist/high Snail/low E-cadherin expression was a significant prognostic predictor in patients with pathological N0 NSCLC.
目的
肺癌是全球癌症相关死亡的主要原因。接受根治性手术且病理 N0 非小细胞肺癌（NSCLC）的患者 5 年生存率仅为 56%，这是由于复发和转移所致。新出现的证据表明，上皮-间充质转化对于癌症转移很重要。Twist 和 Snail 是上皮-间充质转化的调节因子，通过下调 E-钙黏蛋白诱导转移。本研究旨在评估 Twist、Snail 和 E-钙黏蛋白在可切除病理 N0 NSCLC 患者中的表达对预后的影响。
方法
采用免疫组织化学法检测 78 例可切除病理 N0 NSCLC 患者中 Twist、Snail 和 E-钙黏蛋白的表达水平。分析 Twist/Snail/E-钙黏蛋白的表达与总生存（OS）和无复发生存（RFS）的相关性。
结果
在 NSCLC 样本中，Twist、Snail 和 E-钙黏蛋白的高表达率分别为 18%、21%和 53%。Twist 和 Snail 的高表达以及 E-钙黏蛋白的低表达与较差的 RFS 相关[风险比（HR）2.29，95%置信区间（CI）1.07-4.87，P=0.026；HR 2.54，95%CI 1.24-5.20，P=0.008 和 HR 2.41，95%CI 1.23-4.73，P=0.007]和较差的 OS（HR 2.26，95%CI 1.01-5.04，P=0.040；HR 2.56，95%CI 1.20-5.43，P=0.011 和 HR 2.42，95%CI 1.18-4.95，P=0.012）。高 Twist/高 Snail/低 E-钙黏蛋白表达组合中至少 2 个标志物的共表达预测 RFS 和 OS 不良（HR 4.12，95%CI 2.08-8.16，P<0.001 和 HR 4.28，95%CI 2.08-8.77，P<0.001），并且是 RFS 和 OS 的独立预测因子（HR 3.99，95%CI 1.89-8.44，P<0.001 和 HR 4.16，95%CI 1.88-9.18，P<0.001）。
结论
高 Twist/高 Snail/低 E-钙黏蛋白表达组合中至少 2 个标志物的共表达是病理 N0 NSCLC 患者的一个重要预后预测指标。
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