摘要
目的探讨Napsin A蛋白表达和IASLC分级对培美曲塞联合铂类方案一线治疗晚期肺腺癌近期疗效和预后的影响。方法回顾性分析2016年1月至2019年12月563例确诊为ⅢB/Ⅳ期接受表皮生长因子受体(EGFR)基因检测的肺腺癌患者的临床资料。采用免疫组化法检测Napsin A蛋白的表达,分析Napsin A表达和IASLC分级与化疗疗效和患者预后的关系。同时收集化疗前原发灶和化疗后转移灶均接受活检的配对标本9对,观察Napsin A的表达变化。结果563例肺腺癌患者中,107例EGFR突变阴性接受培美曲塞联合铂类方案一线治疗的患者纳入研究。Napsin A的阳性表达率为62.6%(67/107),其表达与性别、吸烟史、年龄和IASLC分级有关(P<0.05)。Napsin A阳性患者的有效率(RR)和疾病控制率(DCR)明显高于Napsin A阴性患者(P<0.001),IASLCⅠ~Ⅱ级患者的DCR高于IASLCⅢ级患者(P=0.037)。107例患者的中位无进展生存时间(PFS)为6.7个月,中位总生存时间(OS)为15.0个月;Napsin A阴性表达者的中位PFS和中位OS分别为5.0个月和10.5个月,低于阳性表达者的9.5个月和18.4个月(P<0.001);IASLCⅠ~Ⅱ级患者的中位PFS和中位OS分别为9.3个月和18.4个月,高于Ⅲ级患者的5.5个月和11.5个月(P<0.001,P=0.002)。Cox多因素分析显示,IASLC分级和Napsin A表达是影响患者PFS和OS的独立因素(P<0.05)。9对化疗前后的配对活检标本中2例转移灶内出现Napsin A表达缺失。结论Napsin A表达和IASLC分级对接受培美曲塞联合铂类药物一线治疗患者的PFS和OS均有重要影响,是预测患者化疗效果和预后的有效指标。
Objective To investigate the effect of Napsin A protein expression and IASLC grade on the efficacy of pemetrexed combined with platinum regimen as the first-line treatment for advanced lung adenocarcinoma.Methods The clinical data of 563 patients with stageⅢB/Ⅳlung adenocarcinoma who underwent epidermal growth factor receptor(EGFR)gene detection from January 2016 to December 2019 were retrospectively analyzed.The expression of Napsin A protein was detected by immunohistochemistry,and the relationship between Napsin A expression and IASLC grade and chemotherapy efficacy and prognosis was analyzed.Meanwhile,9 pairs of matched specimens with biopsy of primary site before chemotherapy and metastasis after chemotherapy were collected to observe the expression of Napsin A.Results Among the 563 patients with lung adenocarcinoma,107 EGFR negative patients receiving pemetrexed plus platinum regimen were included in the study.The positive expression rate of Napsin A was 62.6%(67/107),which was related to gender,smoking history,age and IASLC grade(P<0.05).The effective rate(RR)and disease control rate(DCR)of Napsin A positive patients were significantly higher than those of Napsin A negative patients(P<0.001).The DCR of IASLC gradeⅠ-Ⅱpatients was higher than that of IASLC gradeⅢpatients(P=0.037).The median progression-free survival(PFS)and median overall survival(OS)of 107 patients were 6.7 months and 15.0 months respectively;The median PFS and OS of patients with negative expression of Napsin A were 5.0 months and 10.5 months,respectively,which were lower than those of patients with positive expression for 9.5 months and 18.4 months(P<0.001);The median PFS and OS of patients with IASLC gradeⅠ-Ⅱwere 9.3 months and 18.4 months,respectively,higher than 5.5 months and 11.5 months of patients with IASLC gradeⅢ(P<0.001,P=0.002).Cox multivariate analysis showed that IASLC grade and Napsin A expression were independent factors affecting PFS and OS(P<0.05).In 9 pairs of matched biopsy specimens before and after chem
作者
徐军
陈君平
程兰兰
王健
吕东来
XU Jun;CHEN Junping;CHENG Lanlan;WANG Jian;LV Donglai(Department of Pathology,the 901 Hospital of the Joint Logistics Support Force of PLA,Hefei 230031,China)
出处
《临床肿瘤学杂志》
CAS
2022年第7期583-589,共7页
Chinese Clinical Oncology
基金
联勤保障部队第九〇一医院院管重点课题资助项目(2021YGZD02)。
