Pastorino U, Andreola S, Tagliabue E, Pezzella F, Incarbone M, Sozzi G, Buyse M, Menard S, Pierotti M, Rilke F
Department of Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom.
J Clin Oncol. 1997 Aug;15(8):2858-65. doi: 10.1200/JCO.1997.15.8.2858.
This study investigated the frequency of the expression and prognostic significance of a panel of immunocytochemical markers in resected non-small-cell lung cancer (NSCLC).
A total of 515 cases of pathologic stage I NSCLC were analyzed. The median follow-up time of surviving patients was 102 months. The following immunocytochemical markers were tested: blood group A and precursors of blood antigens; laminin receptor; c-erbB1/epidermal growth factor receptor (EGFR) and c-erbB2/Neu; BCl2; p53; and angiogenesis. Kaplan-Meier estimates of survival and time to recurrence were calculated for clinical variables and biologic markers using the Cox model for multivariate analysis.
The pathologic tumor extension (pT) represented the most powerful prognostic factor for survival (P = .0008) and time to recurrence (P = .0007). None of the immunocytochemical markers emerged as an independent predictive factor for survival. Bcl2-positive tumors showed a better time to recurrence (P = .03), but the difference lost statistical significance in the multivariate analysis. Of interest, in the group of 137 patients classified as pT1N0, both EGFR expression and nonangiogenic type of vascular pattern were associated with a poorer survival (P = .02). However, data derived from subset analysis must be interpreted cautiously.
Our findings do not support a relevant prognostic role of immunocytochemical markers in NSCLC. The evidence is not sufficient to alter clinical practice or even to restrict clinical trials of adjuvant treatments to predefined biologic subsets of patients.
本研究调查了一组免疫细胞化学标志物在切除的非小细胞肺癌（NSCLC）中的表达频率及其预后意义。
共分析了515例病理I期NSCLC病例。存活患者的中位随访时间为102个月。检测了以下免疫细胞化学标志物：血型A及血型抗原前体；层粘连蛋白受体；c-erbB1/表皮生长因子受体（EGFR）和c-erbB2/Neu；Bcl-2；p53；以及血管生成。使用Cox模型对临床变量和生物学标志物进行多因素分析，计算Kaplan-Meier生存估计值和复发时间。
病理肿瘤扩展（pT）是生存（P = .0008）和复发时间（P = .0007）最有力的预后因素。没有一种免疫细胞化学标志物成为生存的独立预测因素。Bcl-2阳性肿瘤的复发时间较好（P = .03），但在多因素分析中该差异失去统计学意义。有趣的是，在137例分类为pT1N0的患者组中，EGFR表达和非血管生成型血管模式均与较差的生存相关（P = .02）。然而，来自亚组分析的数据必须谨慎解释。
我们的研究结果不支持免疫细胞化学标志物在NSCLC中具有相关预后作用。现有证据不足以改变临床实践，甚至不足以将辅助治疗的临床试验限制于预先定义的生物学亚组患者。
