晚期非小细胞肺癌患者胸水液基细胞学蜡块中新抗体D5F3检测的临床价值
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摘要
目的探讨晚期非小细胞肺癌患者胸水液基细胞学蜡块中ALK新抗体D5F3检测的临床价值。方法选择200例经胸膜活检确诊的非小细胞肺癌且胸水发现癌细胞患者的胸水,将其制成液基细胞学蜡块,应用ALK新型抗体D5F3检测该基因蛋白表达情况,分别从阴性、阳性(1～3+)对比其在两种标本中的表达异同。结果 200例液基细胞学蜡块标本检测显示,9例ALK阳性(1～3+),191例ALK (-),阳性率4.5%。阳性胸水的组织学类型均为腺癌,其中,1例(+),5例(2+),3例(3+);≤60岁的6例,>60岁的3例(中位年龄51岁),差异有统计学意义(P<0.05);男性5例,女性4例。与同一患者的胸膜活检标本ALK表达情况完全一致,符合率为100%。结论 ALK蛋白阳性多见于晚期肺腺癌中较年轻的患者,D5F3新抗体在晚期NSCLC患者的胸膜活检组织及胸水液基细胞学蜡块中表达情况一致。胸水液基细胞块可作为检测ALK蛋白的样本。对原发性肺腺癌合并胸膜转移出现恶性胸腔积液的患者,可根据胸腔积液沉渣包埋标本ALK蛋白表达指导临床靶向治疗。
Objective To analyze the clinical value of ALK new antibody D5 F3 in the application of hydrothorax liquidbased cytological wax blocks in patients with advanced non-small cell lung cancer.Methods The pleural effusions of 200 patients diagnosed as non-small cell lung cancer by pleural biopsy and with cancer cell found in the pleural effusion were chosen,and were made into liquid based cytology wax block.ALK D5 F3 new antibody(CST company)was applied to detect the gene protein expression.The similarities and differences of the expression in the two kinds of specimens were compared respectively from the negative and positive(1-3+).Results The results showed that 9 cases were ALK positive(1-3+)and 191 cases were ALK negative(-).There were one case(+),five cases(2+)and three cases(3+).There were six patients aged less than or equal to 60 years old,three patients aged old than 60 years old and the median age was 51,with statistically significant difference(P<0.05).There were five males and four females.The expression of pleural biopsy specimen was completely consistent with that of the same patient,and the coincidence rate was 100%.Conclusion ALK protein positivity is more common in younger patients with advanced lung adenocarcinoma,and D5 F3 expression is consistent in pleural biopsy tissues and hydrothorax cytological wax blocks of advanced NSCLC patients.Hydrothorax-based cells can be used as samples to detect ALK protein.For patients with malignant pleural effusion due to primary lung adenocarcinoma complicated by pleural metastasis,ALK protein expression can be detected according to pleural effusion sediment embedded specimens to guide clinical targeted treatment.
Objective To analyze the clinical value of ALK new antibody D5 F3 in the application of hydrothorax liquidbased cytological wax blocks in patients with advanced non-small cell lung cancer.Methods The pleural effusions of 200 patients diagnosed as non-small cell lung cancer by pleural biopsy and with cancer cell found in the pleural effusion were chosen,and were made into liquid based cytology wax block.ALK D5 F3 new antibody(CST company)was applied to detect the gene protein expression.The similarities and differences of the expression in the two kinds of specimens were compared respectively from the negative and positive(1-3+).Results The results showed that 9 cases were ALK positive(1-3+)and 191 cases were ALK negative(-).There were one case(+),five cases(2+)and three cases(3+).There were six patients aged less than or equal to 60 years old,three patients aged old than 60 years old and the median age was 51,with statistically significant difference(P<0.05).There were five males and four females.The expression of pleural biopsy specimen was completely consistent with that of the same patient,and the coincidence rate was 100%.Conclusion ALK protein positivity is more common in younger patients with advanced lung adenocarcinoma,and D5 F3 expression is consistent in pleural biopsy tissues and hydrothorax cytological wax blocks of advanced NSCLC patients.Hydrothorax-based cells can be used as samples to detect ALK protein.For patients with malignant pleural effusion due to primary lung adenocarcinoma complicated by pleural metastasis,ALK protein expression can be detected according to pleural effusion sediment embedded specimens to guide clinical targeted treatment.
引文
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[11]陈颖,高丽丽,王彦丽,等,间变性淋巴瘤激酶阳性肺腺癌细胞病理学特点初探[J].中华病理学杂志,2015,44(9):628-632.
[12]Solomon B J,Mok T,Kim D W,et al.First line erizotinib versus chemotherapy in ALK.positive lung cancer[J].N Engl J Med,2014,371(23):2167-2177.
[13]杨红,王影,覃胜,等.浆膜腔积液细胞块对提高细胞学诊断及开展基因检测的价值[J].中华临床医师杂志:电子版,20l3,7(21):9489-9493.
[14]张旭超,陆舜,张力,等.中国间变性淋巴瘤激酶(ALK)阳性非小细胞肺癌诊断专家共识(2013版)[J].中华病理学杂志,2013,6(42):402-406.
[2]Zhu J,Cai L,Yang H,et al.Echinoderm microtubuleassociated protein-like 4-anaplastic lymphoma kinase rearrangement and epidermal growth factor receptor mutation coexisting in Chinese patients with lung adenocarcinoma[J].Thoracic Cancer,2014,5(5):411-416.
[3]石远凯,孙燕.非小细胞肺癌分子靶向治疗的发展趋势[J].中华肿瘤杂志,2014,36(7):481-484.
[4]Soda M,Choi Y L,Enomoto M,et a1.Identification of the transforming EMIA.ALK fusion geBe in non small cell lung cancer[J].Nature,2007,448(7153):561-566.
[5]Shaw A T,Yeap B Y,Mino-Kenudson M,et al.Clinical features and outcome of patients with non-small-cell lung cancer who harbor EMIA-ALK[J].J Clin Oncol,2009,27(26):4247-4253.
[6]王丽杰,郭其森.EMIA-ALK融合基因——晚期非小细胞肺癌临床治疗新靶标[J].中华肺部疾病杂志:电子版,2014,7(1):94-97.
[7]Gridelli C,Solange P,Sgambato A,et al.ALK inhibitors in the treatment of advanced NSCLC[J].Cancer Treat Rev,2014,40(2):300-306.
[8]朱翔,李红威,曹宝山,等.525例肺癌中ALK阳性病例临床病理特征研究及检测方法探讨[J].中国肺癌杂志,2014,17(3):226-232.
[9]Xia N,An J,Jiang Q Q.et al.Analysis of EGFR,EMIAALK,KRAS,and c-MET mutations in chinese lung adenocareinoma patients[J].Exp Lung Res,2013,39(8):328-335.
[10]陈学敬,周立娟,董宇杰,等,Ventana全自动免疫组化法检测不同来源肺腺癌ALK蛋白表达一致性的研究[J].诊断病理学杂志,2016,23(4):259-262.
[11]陈颖,高丽丽,王彦丽,等,间变性淋巴瘤激酶阳性肺腺癌细胞病理学特点初探[J].中华病理学杂志,2015,44(9):628-632.
[12]Solomon B J,Mok T,Kim D W,et al.First line erizotinib versus chemotherapy in ALK.positive lung cancer[J].N Engl J Med,2014,371(23):2167-2177.
[13]杨红,王影,覃胜,等.浆膜腔积液细胞块对提高细胞学诊断及开展基因检测的价值[J].中华临床医师杂志:电子版,20l3,7(21):9489-9493.
[14]张旭超,陆舜,张力,等.中国间变性淋巴瘤激酶(ALK)阳性非小细胞肺癌诊断专家共识(2013版)[J].中华病理学杂志,2013,6(42):402-406.