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目的 探讨非小细胞肺癌 (NSCL C)隐匿性纵隔淋巴结转移病灶的基因诊断方法。 方法 应用逆转录聚合酶链反应法 (RT- PCR) ,检测 30例 NSCL C患者 (实验组 ,N0 , a～ b期 )手术后病理诊断为阴性的 138枚纵隔淋巴结中 MU C1基因 m RNA的表达 ,并用 30枚肺良性疾病的局部淋巴结作阴性对照 (阴性对照组 ) ,用 30枚经病理证实有转移的 NSCL C纵隔淋巴结作阳性对照 (阳性对照组 )。对患者进行随访 ,用χ2 检验比较 MUC1基因 m RNA阳性者和阴性者的预后差别。 结果 阴性对照组 30枚肺良性疾病的局部淋巴结均无 MUC1基因 m RNA表达 (特异性为 10 0 % ) ,阳性对照组 30枚经病理证实有转移癌的肺癌纵隔淋巴结中 2 6枚检测到 MUC1基因 m RNA的表达 (敏感性为 87% )。实验组 9例患者的 11枚淋巴结中检测到 MU C1基因 m RNA表达 (检出率 8.0 % ) ,患者的分期上调为 a期。实验组中 MUC1基因 m RNA阳性患者预后不良 ,随访 2年有 4例复发、转移或死亡 ;MUC1基因 m RNA阴性者仅 1例转移 (P<0 .0 5 )。 结论 应用 RT- PCR法检测纵隔淋巴结中 MU C1基因 m RNA的表达可以诊断肺癌隐匿性淋巴结转移。
Objective To investigate the gene diagnosis of occult mediastinal lymph node metastasis in non-small cell lung cancer (NSCL C). Methods RT-PCR was used to detect the mRNA and protein expression of MU C1 gene in 138 mediastinal lymph nodes with pathologic diagnosis of 30 NSCL C patients (experimental group, N0, a-b) (Negative control group) with 30 local lymph nodes of benign lung diseases (negative control group), and 30 NSCL C mediastinal lymph nodes confirmed by pathology were used as positive control (positive control group). Patients were followed up with χ2 test to compare the prognosis of MUC1 gene m RNA positive and negative. Results There was no MUC1 m RNA expression (specificity was 10 0%) in the local lymph nodes of 30 lung benign diseases in the negative control group. Twenty-six of the 30 positive lung cancer mediastinal lymph nodes in the positive control group were found to have MUC1 Gene m RNA expression (sensitivity of 87%). MU C1 gene m RNA expression (detection rate 8.0%) was detected in 11 lymph nodes of 9 patients in the experimental group, and the patients were staged to stage a. MUC1 gene m RNA positive patients in the experimental group had a poor prognosis, with 4 cases of recurrence, metastasis or death in 2 years follow-up; only 1 case of MUC1 gene m RNA negative metastasis (P <0.05). Conclusion Detection of MU C1 gene m RNA in mediastinal lymph nodes by RT-PCR can diagnose occult lymph node metastasis in lung cancer.