非小细胞肺癌影像特征及病理类型联合Ki-67基因表达对术后脑转移的风险分析
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摘要
目的探讨非小细胞肺癌的影像特征、病理类型及其Ki-67抗原表达与术后是否发生脑转移的相关性。方法回顾并追踪随访经手术病理证实的非小细胞肺癌患者110例,所有患者术前均行胸部及颅脑影像学检查、术后明确病理类型并完善标本免疫组化Ki-67检测;术后随访未发生脑转移组83例,发生脑转移组27例。结果 Ki-67表达水平发生脑转移组较未发生脑转移组明显升高,肺部原发肿瘤的大小、形态、胸内淋巴结状态及病理类型在脑转移组与无脑转移组之间存在明显差异,应用Logistic回归分析显示肿瘤的大小、形态、胸内淋巴结状态及病理类型是脑转移的危险因素。结论原发肺部肿瘤的大小、形态、胸内淋巴结状态、病理类型及Ki-67抗原表达与术后脑转移的发生密切相关。
Objective To explore whether certain imaging features,histologic subtypes and ki-67 expression in patients with non-small-cell lung cancer is associated with a higher rate of brain metastases after surgery. Methods A total of 110 patients including 27 cases with primary lung tumor and brain metastasis and 83 control cases with primary lung tumor but no brain metastasis were resected and underwent chest and brain imaging,pathological analysis and immunohistochemical expression of ki-67. Results The gender,age,primary lung tumor location,CT value have no obvious difference between the two groups,while that of the primary tumor size,shape,intrathoracic lymph node status,histological type,Ki-67 antigen expression level make significant contribution for brain metastasis. Multiple factors analysis showed that large tumor,intrathoracic lymph node positive,non squamous cell carcinoma and high Ki-67 expression are risk factors for brain metastases. Conclusion The size of primary lung tumor、status of intrathoracic lymph nodes、pathological type and expression of ki-67 antigen were closely related to the occurrence of postoperative brain metastasis
Objective To explore whether certain imaging features,histologic subtypes and ki-67 expression in patients with non-small-cell lung cancer is associated with a higher rate of brain metastases after surgery. Methods A total of 110 patients including 27 cases with primary lung tumor and brain metastasis and 83 control cases with primary lung tumor but no brain metastasis were resected and underwent chest and brain imaging,pathological analysis and immunohistochemical expression of ki-67. Results The gender,age,primary lung tumor location,CT value have no obvious difference between the two groups,while that of the primary tumor size,shape,intrathoracic lymph node status,histological type,Ki-67 antigen expression level make significant contribution for brain metastasis. Multiple factors analysis showed that large tumor,intrathoracic lymph node positive,non squamous cell carcinoma and high Ki-67 expression are risk factors for brain metastases. Conclusion The size of primary lung tumor、status of intrathoracic lymph nodes、pathological type and expression of ki-67 antigen were closely related to the occurrence of postoperative brain metastasis
引文
[1]石运凯,孙燕,于金明,等.中国肺癌脑转移诊治专家共识(2017版)[J].中国肺癌杂志,2017,20(1):1-9.
[2]Preusser M,Capper D,IIhan-Mutlu A,et al.Brainmetastases:pathobiology and emerging targeted therapies[J].Acta Neurpathol,2012,123(2):205-222.
[3]Belani CP,Liao J.Maintenance therapy for non-small cell lung cancer[J].Lancet,2010,375(9711):281-282.
[4]廖美琳主编.肺癌[M].第1版.北京:中国医药科技出版社,2003:344-347.
[5]Stuschke M,Eberhardt W,Pottgen C,et al.Prophylactic cranial irradiation in locally advanced non-small-cell lung cancer after multimodality treatment:long-term follow-up and investigations of late neuropsychologic effects[J].Clin Oncol,1999,17(9):2700-2709.
[6]Amol Mujoomdar,John HM.Austin.Rohin Malhotra,et al.Clinical Predictors of Metastatic Disease to the Brain from non-small-cell Lung Carcinoma:Primary Tumor Size,Cell Type,and Lymph Node Metastases[J].Radiology,2007,242(3):882-888.
[7]Wisnivesky JP,Yandelevitz D,Henschke CI.Stage of lung cancer in relation to its Size:part 2.Evidence[J].Chest,2005,127(4):1136-1139.
[8]叶雄,王思愚,区伟,等.局部晚期非小细胞肺癌术后脑转移高危因素分析[J].中国肺癌杂志,2007,10(2):111-115.
[9]鲁植燕,桂芳,戈伟,等.P53与肺癌病理、CT征象及预后的关系[J].中国误诊学杂志,2002,2(2):164-167.
[10]Goncalves PH,Peterson SL,Vigneau FD,et al.Risk of brain metastasesin patients with nonmetastatic lung cancer:analysis of the Metropolitan Detroit Surveillance,Epidemiology,and End Results(SEER)data[J].Cancer,2016,122(12):1921-1927.
[11]Kim C,Iee HS,Park J,et al.Prognostic role of p53 and ki-67 immunohistochemical expression in patients wih surgically resected lung adenocarinoma:A retrospective study[J].J Thoracic Dis,2015,7(5):822-833.
[12]李英杰,于长海,李捷,等.PCNA和Ki-67在非小细胞肺癌组织中的表达及其临床意义[J].临床军医杂志,2011,39(2):261-263.
[13]杨慧,吴玉芬,黄勇,等.非细胞肺癌脑转移的危险因素分析[J].山东医药,2015,55(7):41-43.
[14]Shih-Hsin Hsiao,Chi-Li Chung,Yu-Ting Chou,et al.Identification of subgroup patients with stage IIIB/IV non-small cell lung cancer at higher risk for brain metastases[J].lung Cancer,2013,(82):319-323.
[2]Preusser M,Capper D,IIhan-Mutlu A,et al.Brainmetastases:pathobiology and emerging targeted therapies[J].Acta Neurpathol,2012,123(2):205-222.
[3]Belani CP,Liao J.Maintenance therapy for non-small cell lung cancer[J].Lancet,2010,375(9711):281-282.
[4]廖美琳主编.肺癌[M].第1版.北京:中国医药科技出版社,2003:344-347.
[5]Stuschke M,Eberhardt W,Pottgen C,et al.Prophylactic cranial irradiation in locally advanced non-small-cell lung cancer after multimodality treatment:long-term follow-up and investigations of late neuropsychologic effects[J].Clin Oncol,1999,17(9):2700-2709.
[6]Amol Mujoomdar,John HM.Austin.Rohin Malhotra,et al.Clinical Predictors of Metastatic Disease to the Brain from non-small-cell Lung Carcinoma:Primary Tumor Size,Cell Type,and Lymph Node Metastases[J].Radiology,2007,242(3):882-888.
[7]Wisnivesky JP,Yandelevitz D,Henschke CI.Stage of lung cancer in relation to its Size:part 2.Evidence[J].Chest,2005,127(4):1136-1139.
[8]叶雄,王思愚,区伟,等.局部晚期非小细胞肺癌术后脑转移高危因素分析[J].中国肺癌杂志,2007,10(2):111-115.
[9]鲁植燕,桂芳,戈伟,等.P53与肺癌病理、CT征象及预后的关系[J].中国误诊学杂志,2002,2(2):164-167.
[10]Goncalves PH,Peterson SL,Vigneau FD,et al.Risk of brain metastasesin patients with nonmetastatic lung cancer:analysis of the Metropolitan Detroit Surveillance,Epidemiology,and End Results(SEER)data[J].Cancer,2016,122(12):1921-1927.
[11]Kim C,Iee HS,Park J,et al.Prognostic role of p53 and ki-67 immunohistochemical expression in patients wih surgically resected lung adenocarinoma:A retrospective study[J].J Thoracic Dis,2015,7(5):822-833.
[12]李英杰,于长海,李捷,等.PCNA和Ki-67在非小细胞肺癌组织中的表达及其临床意义[J].临床军医杂志,2011,39(2):261-263.
[13]杨慧,吴玉芬,黄勇,等.非细胞肺癌脑转移的危险因素分析[J].山东医药,2015,55(7):41-43.
[14]Shih-Hsin Hsiao,Chi-Li Chung,Yu-Ting Chou,et al.Identification of subgroup patients with stage IIIB/IV non-small cell lung cancer at higher risk for brain metastases[J].lung Cancer,2013,(82):319-323.