【摘要】 目的:探讨β微管蛋白(β-tubulin)在非小细胞肺癌(NSCLC)中的表达情况,及其与诺维本/铂类(NP)术后辅助化疗预后的关系。方法:回顾性分析广州医学院第一附属医院2002年1月至2009年12月收治的84例手术完全切除或部分切除的NSCLC患者,术后以NP方案辅助化疗。应用免疫组织化学S-P法检测患者手术标本β-tubulin中蛋白的表达,进一步分析其与无病生存时间(DFS)和总生存时间(OS)的关系。结果:NSCLC患者中β-tubulin蛋白的低表达率为42.9%(36/84),高表达率为57.1%(48/84),男性β-tubulin高表达患者多于低表达患者(68.2%vs.31.8%,P=0.032);Ⅰ～Ⅱ期β-tubulin高表达患者多于低表达患者(70.7%vs.29.3,P=0.014);且行根治性手术β-tubulin高表达患者多于低表达患者(61.6%vs.38.4%,P=0.032),与NSCLC患者的年龄、病理类型、病理分级、淋巴结转移、吸烟史和放疗均无统计学相关性(P>0.05)。单因素生存分析显示,经低表达β-tubulin的NP方案辅助化疗的NSCLC患者,中位DFS短于高表达者(22.6 vs 69.6个月),两者之间差异无统计学意义(P=0.052),但高表达β-tubulin患者的DFS在术后13个月后明显优于低表达者;进一步分层分析显示,年龄>60岁(P=0.032)、腺癌(P=0.034)、中高分化程度(P=0.028)、不吸烟(P=0.016)的β-tubulin高表达者的DFS均明显优于低表达者。、多因素生存分析显示,β-tubulin的表达(RR=2.213,P=0.025)和临床分期(RR=0.319,P<0.0001)可作为影响DFS的独立预后因素;临床分期(RR=0.426,P=0.010)和放疗(RR=2.381,P=0.026)可作为影响OS预后的独立指标。。结论:在术后辅以NP化疗NSCLC患者中,β-tubulin高表达者预后比低表达者好,术后化疗前对β-tubulin蛋白进行免疫组织化学检测,有利于制定个体化治疗方案,可能改善生存。更多还原

【Abstract】 Objective:To detect the expression ofβ-tubulin in human non-small cell lung carcinoma(NSCLC) and investigate its relationship with prognosis following post-operative adjuvant vinorelbine/platinum chemotherapy.Methods:This article retrospectively analyzed 84 patients with NSCLC who had undergone adjuvant vinorelbine/platinum chemotherapy.The expression ofβ-tubulin protein was examined by immunohistochemistry(SP method).The relationships ofβ-tubulin with disease-free survival(DFS) and overall survival (OS) were analyzed.Results:Lowβ-tubulin expression was identified in 36 of 84 samples(42.9%),and highβ-tubulin expression was identified in 48 of 84 samples(57.1%).We found that in male(68.2%vs.45.0%,P=0.032),stagesⅠ～Ⅱ(70.7%vs.44.2%,P=0.014),radical surgery(61.6%vs.38.4%,P=0.032),highβ-tubulin expression was more frequent than low expression.Highβ-tubulin expression was not associated with age,pathological type,pathological grade,history of smoking,metestasis status,and radiotherapy status(P>0.05).Univariate analysis showed that the median DFS was significantly worse in NSCLC patients with lowβ-tubulin expression after adjuvant vinorelbine chemotherapy than in those with highβ-tubulin expression(22.6 mo vs.69.6 mo).However,the difference was not statistically significant (P > 0.05).DFS was significantly better in patients with high expression than those with low expression 13 mo after surgery.Furthermore, we found that NSCLC patients,aged more than 60 yr,with highβ-tubulin expression(P=0.032),adenocarcinoma(P=0.034),moderately to highly differentiated diseases(P=0.028),and were non-smokers(P=0.016) had significantly better DFS than those with low expression. Multivariate Cox regression analysis showed thatβ-tubulin(RR=2.213,P=0.025) and the clinical TNM stage(RR=0.319,P<0.0001) are significant independent predictors of DFS for patients with lung cancer,whereas the clinical TNM stage(RR=0.426,P=0.010) and radiotherapy status(RR=0.38,P=0.026) was a significant independent predictor of OS for patients with non-small lung cancer.Conclusion:β-tubulin expression in NSCLC is related to the prognosis following adjuvant vinorelbine chemotherapy in operable NSCLC.High expression is associated with a better prognosis than low expression.β-tubulin is detectable by immunohistochemical methods after operation,which makes it a favorable consideration for individualized treatment plans,and may improve survival.更多还原