检测非小细胞肺癌患者纵隔淋巴结微转移的临床意义  

Clinical Significance of Detection of Micrometastasis of Mediastinal Lymph Nodes in Patients with Non-small Cell Lung Cancer

作　　者：特木热[1] 扎那顺巴雅尔 黄少君[1] 

机构地区：[1]内蒙古医科大学附属医院胸外科,内蒙古呼和浩特010050 [2]内蒙古自治区医院肿瘤科,内蒙古呼和浩特010017

出　　处：《内蒙古医学杂志》2012年第7期769-773,共5页Inner Mongolia Medical Journal

摘　　要：目的：采用分子生物学方法检测非小细胞肺癌（Non-small Cell Lung Cancer,NSCLC）患者纵隔淋巴结微转移情况,分析其与患者临床特征之间的关系,为临床合理的纵隔淋巴结廓清范围提供依据,使术后外科病理分期更加精确,以更好地拟定术后治疗方案。方法：随机选取2006年11月~2007年12月间在内蒙古医科大学附属医院胸心外科行肺癌根治术后的37例NSCLC患者为对象,应用逆转录聚合酶链反应（RT-PCR）技术,检测其术后常规病理学检查阴性的纵隔淋巴结中MUC1 mRNA基因的表达,以明确是否存在微转移灶。分析非小细胞肺癌患者纵隔淋巴微转移与原发肿瘤大小、年龄、性别、吸烟、肿瘤位置、组织学类型、分化程度、外科病理分期（P-FNM）、淋巴结大小、淋巴结融合之间的相关性。结果：在37例患者常规病理学检查阴性的50枚纵隔淋巴结中,13例患者的20枚淋巴结检出微转移灶,阳性率为35.1%（13/37）,其中P-N0期纵隔淋巴结微转移率为29.2%（7/24）,P-N1期为46.2%（6/13）。微转移与原发肿瘤大小、年龄、性别、吸烟之间无明显相关性（P〉0.05）,但与肿瘤位置、组织学类型、分化程度、分期、淋巴结大小、淋巴结融合情况等有一定的相关性（P〈0.05）。外科病理分期（p-TNM）与分子TNM分期方法之间总符合率为64.9%,两者之间有统计学差异（P〈0.05）。结论：RT-PCR方法检测纵隔淋巴结MUClmRNA基因对非小细胞肺癌患者的预后及指导术后治疗有临床应用价值,并有望成为非小细胞肺癌患者手术后精确TNM分期一个重要的手段,可使目前的肿瘤TNM分期更加精确。Objective：To investigate micrometastasis of mediastinal lymph nodes in patients with non-small cell lung cancer（NSCLC）by the way of molecular biology and to analyse the cot-relation between micrometastasis and the clinical characteristics.And to provide reasonable clinical base for the scavenge extent of mediastinal lymph nodes,and also to adjust the stage of pathology in surgery after operation,laying a better treatment plan.Methods：37 patient.with NSCLC after radical correction from Cardiothoracic Surgery of the first Affiliated Hospitalof Inner Mongolia Medical College during the period from November 2006 to December 2007 The gene expression of MUC 1 mRNA from mediastinal lymph nodes determined negative by routine histopathological examination Was analysed by reverse transcriptase-poiymerase chain reaction（RT-PGR）to confirm wheather there are focus of micrometastasis.To analyse the correlation between micrometastasis and the size of primartumor,age,sex,smoking,location of tumour,histological category,degee of cell differentiation,stage of pathology in surgery（p-TNM）,size of lymph nodes,and fusion between lymph nodes.Results： Among 50 lymph nodes determined negative by routine histopathological examination in 37 patients,13 patients with focus of micrometastasis in mediastinal lymph nodes（positive rate：35.1%,stage P-N0 and ps-N1 were 29.2% and 46.2%respectively）No correlation was found between mi-crometastasis and size of primartumor,age,sex,smoking（P0.05）,while correlation was found between micrometastasis and location of tumour,histological category,degree of cell differentiation,stage of pathology in surgery,size of lymph nodes,and fusion between lymph nodes（P0.05）.The total coincidence between stage of pathology in surgery and molecular stage（TNM）was 64.9%（P0.05）.Conclusions： Detection of gene expression of MUGl mRNA from mediastinal lymph nodes by RT-PGR was of significance to prognosis and curepatients with non-small cell lung cancer（NSCLG）in clinial applicati

关 键 词：非小细胞肺癌 微转移 淋巴结 粘蛋白1 RT-PCR 

分 类 号：R734.2[医药卫生—肿瘤]