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目的:检测细胞凋亡通路蛋白Mcl1和Fbw7对晚期非小细胞肺癌患者预后的预测作用。方法:收集2008年3月至2011年6月在第四军医大学第一附属医院西京医院确诊晚期非小细胞肺癌且最初两个化疗周期采用“多西他赛+顺铂”方案的患者,通过电话和信件进行随访。用免疫组化方法检测患者肿瘤蜡块组织中蛋白Mcl1和Fbw7表达,用H评分系统将蛋白表达分为高表达组和低表达组。统计采用Kaplan-Meier法进行单因素生存分析并进行Log-Rank检验,通过比例风险模型(Cox模型)逐步后退法进行多因素分析,以P<0.05为有显著差异。结果:共收集病例144例,其中腺癌69例,鳞癌64例,其它11例。Ⅲ期患者45例(31.25%)Ⅳ期患者99例(68.75%).64例(44.44%)患者Mcl1高表达,80例(55.56%)患者Mcl1低表达。单因素结果提示TNM分期是提示预后的显著因素(P=0.033),Ⅲ期患者1年生存率为74.20%(中位生存时间为666天),Ⅳ期患者1年生存率为55.60%(中位生存时间为415天)。Mcl1的表达与晚期非小细胞肺癌预后相关联(P=0.042),其中Mcl1高表达组1年生存率为69.9%(中位生存时间为612天),Mcl1低表达组1年生存率为55.30%(中位生存时间为406天)。多因素分析结果显示Mcl1(OR=1.809,95%CI(1.123-2.912),P=0.015)和TNM分期(OR=0.573,95%CI(0.336-0.978),P=0.041)有独立的预后意义。结论:Mcl1蛋白表达和TNM分期是晚期非小细胞肺癌的独立预后因素,Mcl1高表达组较低表达组有更好的预后,Ⅲ期患者比Ⅳ期患者有更好的预后。
Objective: To detect the prognostic value of apoptotic pathway proteins Mcl1 and Fbw7 in patients with advanced non-small cell lung cancer. Methods: Patients with newly diagnosed advanced non-small cell lung cancer diagnosed in the Xijing Hospital of the First Affiliated Hospital of the Fourth Military Medical University from March 2008 to June 2011 were enrolled and the first two chemotherapy cycles were given “docetaxel + cisplatin” Follow up by phone and mail. Immunohistochemistry was used to detect the expression of Mcl1 and Fbw7 protein in the tumor paraffin blocks. The protein expression was divided into high expression group and low expression group using H score system. Statistical analysis Kaplan-Meier method was used to carry out one-way survival analysis and log-rank test, and multivariate analysis was carried out by progressive regression method of proportion risk model (Cox model). P <0.05 was considered as significant difference. Results: A total of 144 cases were collected, including 69 cases of adenocarcinoma, 64 cases of squamous cell carcinoma and the other 11 cases. Among 45 patients (31.25%) in stage Ⅲ, 99 (68.75%) were stage Ⅳ patients, Mcl1 was highly expressed in 64 patients (44.44%), and Mcl1 was low in 80 patients (55.56%). The univariate analysis suggested that TNM staging was a significant factor in prognosis (P = 0.033). The 1-year survival rate was 74.20% (median survival time was 666 days) in stage III patients and 55.60% in stage IV patients Bit survival time of 415 days). The Mcl1 expression was correlated with the prognosis of advanced non-small cell lung cancer (P = 0.042). The 1-year survival rate was 69.9% (median survival time was 612 days) in Mcl1 overexpression group and 55.30 % (Median survival time of 406 days). Multivariate analysis showed that Mcl1 (OR = 1.809,95% CI (1.123-2.912), P = 0.015) and TNM stage (OR = 0.573,95% CI 0.336-0.978, P = 0.041) had independent prognostic significance . Conclusion: Mcl1 protein expression and TNM stage are independent prognostic factors for advanced non-small cell lung cancer. Mcl1 high expression group has a better prognosis than low expression group, and stage Ⅲ patients have better prognosis than stage Ⅳ patients.