摘要
目的 分析循环肿瘤细胞(CTCs)、增殖细胞核抗原(PCNA)、膜联蛋白A2(ANXA2)水平在非小细胞肺癌(NSCLC)患者中的变化,并探讨其与NSCLC患者不同临床病理特征和预后的关系。方法 选取2015年1月至2016年6月期间石家庄市人民医院呼吸内科收治的NSCLC患者115例作为癌症组,100例肺部良性病变患者作为良性组,收集同期体检中心健康体检者100例作为对照组,回顾性分析3组研究对象的临床资料,比较CTCs、PCNA、ANXA2在3组研究对象间表达的差异,通过每周电话随访的方式对患者进行定期随访,记录NSCLC患者50个月的生存情况。利用Cox回归分析影响NSCLC患者预后的独立危险因素,采用Kaplan-Meier法进行生存分析。结果 癌症组患者CTCs、PCNA、ANXA2水平明显高于良性组和对照组,良性组高于对照组,差异均有统计学意义(P<0.05)。以肺癌的病理切片结果为金标准,CTCs、PCNA、ANXA2诊断肺癌的受试者工作特征(ROC)曲线显示,三者联合检测诊断肺癌的曲线下面积是0.958,灵敏度92.0%,特异度94.6%。根据不同病理特征进行单因素分析,CTCs、PCNA、ANXA2在有吸烟史、肿瘤直径≥5 cm、TNM分期为Ⅲ~Ⅳ期、分化程度为低分化、有淋巴结转移、有远处转移的患者中明显升高,差异有统计学意义(P<0.05)。据Pearson相关性分析可知CTCs、PCNA、ANXA2与NSCLC患者的肿瘤直径(r=0.602、0.543、0.743)、TNM分期(r=0.238、0.307、0.342)、淋巴结转移(r=0.391、0.387、0.421)、远处转移(r=0.296、0.274、0.198)呈正相关,与分化程度(r=-0.334、-0.372、-0.403)呈负相关(P<0.05)。Cox回归分析结果显示,TNM分期、分化程度、淋巴结转移、远处转移以及CTCs、PCNA、ANXA2阳性表达是NSCLC患者预后不良的独立危险因素(P<0.05)。Kaplan-Meier生存曲线显示CTCs、PCNA、ANXA2高水平表达与NSCLC患者生存期密切相关。结论 CTCs、PCNA、ANXA2在NSCLC患者中明显升高,且与不同临床病理特征密切相关,是预后不良的独立危险因素,联合检测有助于疾病早期诊断及预后判断。
Objective To analyze the changes of circulating tumor cell(CTCs), proliferating nuclear antigen(PCNA), and annex protein A2(ANXA2) levels in patients with non-small cell lung cancer(NSCLC), and to explore the relationship between CTCs and different clinicopathologic features and prognosis of NSCLC patients. Methods A total of 115 NSCLC patients admitted to the Respiratory Department of Shijiazhuang People’s Hospital from January 2015 to June 2016 were selected as the cancer group, 100 patients with benign lung lesions were selected as the benign group, and 100 healthy patients from the Physical Examination Center during the same period were collected as the control group. The clinical data of the three groups of subjects were retrospectively analyzed. The differences in the expression of CTCs, PCNA, and ANXA2 of the three groups were compared, and the patients were followed up regularly through weekly telephone follow-up to record the survival of NSCLC patients for 50 months. Cox regression was used to analyze the independent risk factors affecting the prognosis of NSCLC patients, and Kaplan-Meier method was used for survival analysis. Results The levels of CTCs, PCNA and ANXA2 in cancer group were significantly higher than those in benign group and control group, and those in benign group were higher than those in control group, with statistical significance(P<0.05). Taking the results of lung cancer pathological sections as the gold standard, the subject work curve of CTCs, PCNA and ANXA2 for the diagnosis of lung cancer showed that the area under the curve of the combined detection of CTCS, PCNA and ANXA2 was 0.958, the sensitivity was 92.0%, and the specificity was 94.6%. According to univariate analysis based on different pathological features, CTCs, PCNA and ANXA2 significantly increased in patients with smoking history, tumor diameter ≥5 cm, TNM stage Ⅲ~Ⅳ, low differentiation, lymph node metastasis or distant metastasis, and the difference was statistically significant(P<0.05). Pearson correlation analysis showed that CTCs, PCNA, ANXA2 and NSCLC patients had tumor diameter(r=0.602, r=0.543, r=0.743), TNM stage(r=0.238, r=0.307, r=0.342), lymph node metastasis(r=0.391, r=0.387, r=0.421) and distant metastasis(r=0.296, r=0.274, r=0.198) were positively correlated with the degree of differentiation(r=-0.334, r=-0.372, r=-0.403)(P<0.05). Cox regression analysis showed that TNM stage, differentiation degree, lymph node metastasis, distant metastasis, and positive expression of CTCs, PCNA, and ANXA2 were independent risk factors for poor prognosis in NSCLC patients. Kaplan-meier survival curve showed that high levels of CTCs, PCNA and ANXA2 were closely related to the survival of NSCLC patients. Conclusions CTCs, PCNA and ANXA2 significantly increase in NSCLC patients, which are closely related to different clinicopathological features and are independent risk factors for poor prognosis. Combined detection is helpful for early diagnosis and prognosis.
作者
王传
顾晓静
史金英
夏静荣
陈洁
WANG Chuan;GU Xiaojing;SHI Jinying;XIA Jingrong;CHEN Jie(Department of Respiratory Medicine,Shijiazhuang People’s Hospital,Shijiazhuang 050000,China)
出处
《安徽医学》
2023年第3期262-267,共6页
Anhui Medical Journal
基金
河北省卫生厅课题(编号:20181018)。
关键词
非小细胞肺癌
循环肿瘤细胞
增殖细胞核抗原
膜联蛋白A2
临床病理特征
预后
Non-small cell lung cancer
Circulating tumor cell
Proliferating nuclear antigen
Annexin A2
Clinicopathological features
Prognosis
