非小细胞肺癌RARβ基因启动子CpG岛甲基化与P53基因突变的关系

目的 研究非小细胞肺癌(non-small cell lung cancer,NSCLC)维甲酸受体β(retinoid acid receptorβ,RAR)基因甲基化与P53基因突变的关系.方法 应用甲基化特异性PCR以及PCR产物直接测序法分别检测198例原发性NSCLC组织中RARβ启动子CpG岛甲基化以及P53基因第5～9外显子的突变情况.结果 RARβ甲基化和P53突变检出率分别为58.1％和36.4％.在吸烟及男性患者中二者检出率分别高于非吸烟及女性患者;TNMⅠ期以上患者RARβ甲基化率高于Ⅰ期患者;鳞癌和腺鳞癌中P53突变率均高于腺癌(P＜0.05).RARβ甲基化的癌组织,其P53 G:C＞T:A型突变、颠换及错义突变率均高于RARβ非甲基化的癌组织(P＜0.05).P53 G:C＞T:A型而不是其他类型突变的癌组织,其RARβ甲基化率高于P53未突变的癌组织(P＜0.05);在调整性别、年龄后该差异在整组肺癌患者(OR=3.737,95％CI:1.414～9.873)、吸烟者(OR=4.020,95％CI:1.263～12.800)、鳞癌患者(OR=5.480,95％CI:1.400～21.446)、TNM Ⅰ期以上患者(OR=3.446,95％CI:1.054～11.267)中均有统计学意义(P＜0.05).结论 非小细胞肺癌RARβ甲基化与P53 G:C＞T:A型突变有关.     

TSGF和CEA检测对非小细胞肺癌诊断的临床价值

探讨恶性肿瘤特异性生长因子（TSGF）和癌胚抗原（CEA）对非小细胞肺癌（NSCLC）治疗预后判断的临床价值,本文对99例NSCLC患者用电化学发光免疫分析法检测血清TSGF和CEA水平,比较患者不同病理类型、不同临床分期血清TSGF和CEA的阳性率。结果表明：血清TSGF和CEA的阳性率与NSCLC临床分期和病理类型有关;临床分期越晚,其阳性率越高;TSGF和CEA联合检测可用于观察NSCLC患者的治疗疗效和协助制定正确有效的治疗方案。     

p16、DAPK和RARβ基因启动子CpG岛甲基化与非小细胞肺癌临床特征的关系

目的 研究非小细胞肺癌(non-smal celllung cancer,NSCLC)患者p16、DAPK和RARβ启动子区CpG岛甲基化对临床特征的影响,探讨其与吸烟的关系.方法 应用甲基化特异性PCR检测200例原发性NSCLC组织和相应正常组织中p16,DAPK和RARβ基因启动子区CpG岛甲基化状况.结果 p16、DAPK和RARβ基因甲基化在癌组织中的检出率分别为51.0%、60.0%和58.0%,均高于其在正常组织中的检出率(分别为12.5%,11.5%和15.0%;P＜0.05).非条件Logistic回归显示,癌组织p16基因甲基化与年龄和病例组织类型有关(P＜0.05);癌组织DAPK基因甲基化与年龄、性别、临床分类有关(P＜0.05);而癌组织RARβ基因甲基化与临床分类和TNM(tumor node metastasis)分期相关(P＜0.05).癌组织p16基因甲基化与DAPK基因甲基化之间存在交互作用(OR=1.987,95%CI:1.055～3.743).吸烟者癌组织p16和DAPK基因甲基化的OR值分别为3.139(95%CI:1.046～9.419)和3.585(95%CI:1.270～10.123),未发现癌组织RARβ基因甲基化与吸烟有关.结论 p16,DAPK和RARβ甲基化与NSCIC患者临床特征关系密切.吸烟与p16和DAPK基因甲基化有关.

Abstract：

Objective To investigate the effects of promoter methylation of p16 , death-associated protein kinase (DAPK) and retinoic acid receptor-β (RARβ) genes on clinical data in non-small cell lung cancers, and to study the effect of smoking on the risk of gene methylation. Methods The promoter methylation of p16 , DAPK and RARβ genes in 200 primary non-small cell lung cancers and the corresponding nonmalignant lung tissues were determined by methylation-specific PCR. Results Methylation in the tumor tissues was detected in 51.0% for p16 , 60.0% for DAPK, and 58. 0% for RARβ gene, with significant differences (P ＜ 0. 05) when compared with those in the corresponding nonmalignant tissues (12. 5%,11.5% and 15.0%) respectively. p16 gene methylation in tumor tissue was associated with age significantly in unconditional logistic regression analysis (P＜0.01) and histologic type (P＜0. 05). DAPK gene methylation in tumor tissue was associated significantly with age (P＜0. 05), gender (P＜0.05) and clinical type (P＜ 0.05 ). RARβ gene methylation in tumor tissue was associated with clinical type (P＜0. 05) and tumor stage (P＜0. 05) significantly. The interaction odds ratio (OR) for the gene-gene interaction in tumor tissue between p16 and DAPK was 1. 987 (95%CI: 1. 055-3. 743). The results of the gene-smoking analyses revealed that a relationship existed between cigarette smoking and p16 gene methylation (OR= 3. 139, 95 % CI: 1. 046-9. 419), the OR for the relationship of DAPK gene methylation and cigarette smoking was 3. 585(95%CI: 1. 270-10. 123)in tumor tissue. The RARβ gene methylation did not differ based on the smoking status of patients in tumor tissue. Conclusion Thep16 , DAPK and RARβ genes methylation are strongly associated with clinical data of non-small cell lung cancer, and methylation of p16 and DAPK genes are associated with tobacco smoking.     

针吸活检与基因突变检测诊断非小细胞肺癌的临床价值

目的探讨经支气管镜针吸活检(Transbronchial needle aspiration,TBNA)组织学和基因突变检测在非小细胞肺癌的分型诊断及治疗中的价值。方法探讨经支气管镜针吸活检组织学和基因突变检测在非小细胞肺癌的分型诊断及治疗中的价值。结果进行TTF-1、p63、ck7、ck5/6特异性标记物免疫组化检测的28例TBNA样本的检测结果为:鳞癌15例,腺癌13例。其中10例腺癌进行了EGFR/KRAS/ALK的基因突变检测,检出EGFR突变阳性2例,KRAS阳性1例,未检测到ALK突变。结论通过TTF-1、p63、ck7、ck5/6特异性标记物联合基因突变检测可以较准确区分出鳞癌和腺癌,为临床用药提供指导。     

非小细胞肺癌中九基因联合检测突变分析

目的通过ARMS-PCR法联合检测非小细胞肺癌(non-small cell lung cancers, NSCLC)中9个驱动基因(ALK、ROS1、RET、EGFR、KRAS、HER-2、PIK3CA、NRAS和BRAF)的突变情况,分析其突变状态及临床意义。方法采用ARMS-PCR技术检测2018年2月～2019年2月陆军军医大学第一附属医院病理科存档的522例NSCLC肿瘤组织中的9个驱动基因的突变情况。结果 522例NSCLC中ALK、ROS1和RET的融合突变率分别为5.17%、1.34%、1.34%,EGFR、KRAS、HER-2、PIK3CA、NRAS和BRAF的突变率分别为47.32%、7.28%、1.72%、1.72%、0.95%和0.57%。女性患者中EGFR突变和ALK融合突变率明显高于男性患者(P0.001),而KRAS突变率低于男性患者(P0.001)。EFGR和KRAS突变在肺腺癌中显著高于肺鳞癌(P0.001)。无吸烟史患者中EGFR突变和ALK融合发生率均高于吸烟患者(P0.001),KRAS突变在吸烟患者的发生率显著高于无吸烟史患者。利用ARMS法联合检测9个基因在单点检测EGFR基础上增加了10.15%的患者可使用靶向药物(P0.01)。结论在9个驱动基因突变中,EGFR突变、ALK融合、KRAS突变与患者性别、吸烟以及组织学类型密切相关,其它较为罕见驱动基因突变并未发现与组织学类型、患者性别及吸烟与否相关。九基因联合检测可作为NSCLC更简便适用的药物靶向检测方法。     

CYFRA21-1联合PTEN检测对非小细胞肺癌诊断价值分析

目的 探讨细胞角蛋白-19片断抗原(CYFRA21-1)和第10染色体同源丢失性磷酸酶-张力蛋白酶基因(phosphatase and tensin homolog deleted on chromosome ten,PTEN)表达在非小细胞肺癌(non-small cell lung cancer,NSCLC)诊断中的作用及其联合检测的临床价值.方法 选取126例NSCLC和同期35例良性肺疾病患者,收集患者年龄、病理类型和淋巴结转移等临床指标,电化学发光法检测血清肿瘤标志物CYFRA21-1水平,实时荧光定量PCR(quantitative real-time PCR,qPCR)法检测PTEN mRNA的表达情况.结果 肿瘤标志物结果显示,NSCLC患者组血清CYFRA21-1阳性率为75.4％,良性肺疾病患者组为54.3％,差异有统计学意义(P ＜0.05);qPCR结果显示,NSCLC组织中PTEN mRNA表达显著低于良性肺疾病患者组,差异有统计学意义(P＜0.01),且PTEN mRNA表达与临床分期和淋巴结转移显著相关(P＜0.01).结论 NSCLC患者血清CYFRA21-1水平及组织中PTEN mRNA低表达,提示CYFRA21-1联合PTEN检测将为未来NSCLC诊断方面提供新思路.     

非小细胞肺癌p16基因异常与临床病理相关性研究

目的　探讨抑癌基因p16在非小细胞肺癌中的失活方式、mRNA和p16蛋白表达与临床病理因素的相关性。方法　应用对比性多重聚合酶链式反应检测 6 4例非小细胞肺癌中p16基因启动子的甲基化状况 ,同时应用原位杂交和免疫组织化学方法 [链霉素抗生物素蛋白 过氧化物酶 (SP)法 ]检测p16基因的mRNA和蛋白表达水平 ,并将上述结果与非小细胞肺癌之临床病理因素进行了相关性研究。结果　 5 6 3% (36 / 6 4 )的肺癌标本被检出有p16基因启动子甲基化 ,且甲基化与p16蛋白表达呈负相关 (P <0 0 5 ) ;免疫组织化学检测结果显示 ,5 7 8% (37/ 6 4 )的标本呈现p16蛋白表达缺失 ;原位杂交检测有 2 0 3% (13/ 6 4 )的标本被检出p16mRNA表达 ,且这 13例阳性者的p16蛋白也表达。同时具有p16基因启动子甲基化和蛋白表达缺失的非小细胞肺癌患者淋巴结转移率明显增高 ,术后生存期明显降低 (P <0 0 5 )。结论　启动子甲基化是导致非小细胞肺癌p16基因失活的主要方式 ,同时具有p16基因启动子甲基化及p16蛋白表达异常的患者预后不良     

非小细胞肺癌中RET融合基因的研究进展

存在于1%~2%的非小细胞肺癌患者中的RET融合基因具有鲜明的临床病理学特征,且RET抑制剂对其治疗有效,提示RET融合基因已成为该类患者个体化分子靶向治疗的新靶点。本文将对RET融合基因的特点及其在非小细胞肺癌(non-small cell lung cancer,NSCLC)患者中的表达和治疗的研究进展进行阐述。     

非小细胞肺癌中p16基因的突变研究

目的　探讨ｐ１６ 基因在非小细胞肺癌发生发展过程中所起作用。方法　应用 Ｐ Ｃ Ｒ 与双链 Ｄ Ｎ Ａ 直接测序技术对４０ 例非小细胞肺癌中ｐ１６ 基因外显子２ 的纯合缺失与序列改变进行了研究。结果４０ 例非小细胞肺癌中有２ 例存在ｐ１６ 基因外显子２ 的纯合缺失；１４ 例肿瘤 Ｄ Ｎ Ａ 样品中检出ｐ１６ 基因外显子２ 的１９ 个点突变和１ 个移码突变。其中８ 个突变位于１２１ 位密码子中３８０ 位碱基处。结论　ｐ１６ 基因点突变在非小细胞肺癌中发生频率较高，是参与非小细胞肺癌发生发展的主要突变形式。非小细胞肺癌中ｐ１６ 基因的突变热点为１２１ 位密码子中３８０ 位碱基的转换与颠换。     

非小细胞肺癌患者紧密连接蛋白-1基因启动子甲基化分析及其临床意义

目的 探讨非小细胞肺癌(NSCLC)患者中紧密连接蛋白-1(ZO-1)基因甲基化检测的临床意义.方法应用甲基化特异性聚合酶链反应MS-PCR检测101例NSCLC患者癌组织及癌旁组织ZO-1基因启动子甲基化状态,以61例肺部良性病变患者作为对照,并用实时荧光定量PCR和Western blotting分别检测63例甲基...     

联合检测7种自身抗体在非小细胞肺癌中的诊断价值

目的 探讨7种肿瘤相关抗原自身抗体在非小细胞肺癌诊断中的应用价值.方法 回顾性分析非小细胞肺癌患者443例、体检健康人群405例,采用ELISA法检测各组血清中7种自身抗体的水平,分析抗体水平组间及阳性率差异,绘制ROC曲线分析单个抗体和联合检测的诊断效能,结合病理诊断结果 分析联合检测的阳性率与肺癌临床病理特征的关系...     

Prognostic value of P53 protein in cells of non-small cell lung cancer

The aim of the study was to evaluate the prognostic relevance of p53 protein in non-small cell lung cancer. The 95 surgically treated patients were included (53 patients with squamous cell carcinoma, 29--with adenocarcinoma, 5--with large cell carcinoma, and 8--with mixed type). The protein was assessed immunohistochemically with the use of monoclonal antibodies DO7, DAKO. Positive staining was present in 44 patients. There was no survival difference between groups with and without protein (median survival--36 and 33 months, respectively; p = 0.86). In the multivariate analysis the only characteristics with prognostic impact in the entire group was stage of the disease. There was no correlation between the expression of p53 protein and disease-free survival. These results indicate that there is no prognostic relevance of p53 protein in non-small cell lung cancer.     

Prognostic assessment of apoptotic gene polymorphisms in non-small cell lung cancer in Chinese

Apoptosis plays a key role in inhibiting tumor growth, progression and resistance to anti-tumor therapy. We hypothesized that genetic variants in apoptotic genes may affect the prognosis of lung cancer. To test this hypothesis, we selected 38 potentially functional single nucleotide polymorphisms (SNPs) from 12 genes (BAX, BCL2, BID, CASP3, CASP6, CASP7, CASP8, CASP9, CASP10, FAS, FASLG and MCL1) involved in apoptosis to assess their prognostic significance in lung cancer in a Chinese case cohort with 568 non-small cell lung cancer (NSCLC) patients. Thirty-five SNPs passing quality control underwent association analyses, 11 of which were shown to be significantly associated with NSCLC survival (P < 0.05). After Cox stepwise regression analyses, 3 SNPs were independently associated with the outcome of NSCLC (BID rs8190315: P = 0.003; CASP9 rs4645981: P = 0.007 and FAS rs1800682: P = 0.016). A favorable survival of NSCLC was significantly associated with the genotypes of BID rs8190315 AG/GG (adjusted HR = 0.65, 95% CI: 0.49-0.88), CASP9 rs4645981 AA (HR = 0.22, 95% CI: 0.07-0.69) and FAS rs1800682 GG (adjusted HR = 0.67, 95% CI: 0.46-0.97). Time-dependent receptor operation curve (ROC) analysis revealed that the area under curve (AUC) at year 5 was significantly increased from 0.762 to 0.819 after adding the risk score of these 3 SNPs to the clinical risk score. The remaining 32 SNPs were not significantly associated with NSCLC prognosis after adjustment for these 3 SNPs. These findings indicate that BID rs8190315, CASP9 rs4645981 and FAS rs1800682 polymorphisms in the apoptotic pathway may be involved in the prognosis of NSCLC in the Chinese population.     

p21活化激酶4在非小细胞肺癌中的表达及其临床意义

目的:探讨p21活化激酶4(PAK4)在人非小细胞肺癌细胞系及人非小细胞肺癌组织中的表达及其临床意义。方法:采用Western blot及实时荧光定量PCR检测人支气管上皮(HBE)细胞、非小细胞肺癌细胞(A549、NCI-H520、NCI-H460和NCI-H596细胞)、20例新鲜非小细胞肺癌组织及相应的癌旁组织中PAK4的表达情况;采用免疫组化检测210例非小细胞肺癌组织PAK4的表达情况;采用Kaplan-Meier法评估非小细胞肺癌患者术后5年生存率;用Cox比例风险模型分析PAK4对患者预后的影响。结果:非小细胞肺癌细胞(A549、NCI-H520、NCI-H460和NCI-H596细胞)PAK4蛋白及mRNA表达均显著高于HBE细胞(P0.05);20例非小细胞肺癌组织中PAK4蛋白及mRNA表达高于癌旁组织PAK4蛋白及mRNA表达(P0.05);10例转移性非小细胞肺癌组织PAK4 mRNA表达显著高于10例原发性非小细胞肺癌组织(P0.05);免疫组化染色结果示210例非小细胞肺癌PAK4评分显著高于对应的癌旁组织。临床资料分析显示PAK4蛋白表达与非小细胞肺癌的分化程度、淋巴结转移、远处转移及临床分期有关(P0.05);PAK4高表达组患者5年生存率显著低于PAK4蛋白低表达组患者(logrank检验,P0.05),PAK4蛋白表达是非小细胞肺癌患者的独立预后因素。结论:PAK4蛋白高表达是非小细胞肺癌患者死亡的独立危险因素。     

Stathmin在非小细胞肺癌中表达增强* 基金项目：辽宁省科学技术计划立项课题资助（编号：2007225005-13）

 摘要:目的 探讨Stathmin在非小细胞肺癌（non-small cell lung cancer, NSCLC）组织中和正常组织中的表达,了解其与NSCLC临床病理特征之间的关系。方法 用免疫组化与RT-PCR方法,检测43例NSCLC 术后癌组织及正常组织标本中Stathmin蛋白与mRNA的表达。结果 Stathmin蛋白和基因在NSCLC中阳性表达率分别为62.79%和67.44%,显著高于正常组织的16.28%和20.93%（P＜0.01）,其表达与肿瘤细胞分化程度和有无淋巴结转移有关（P ＜0.05）。结论 Stathmin在NSCLC的发生发展过程中起了重要作用,可能成为预测NSCLC恶性程度的新的生物学及个体化治疗的敏感指标。     

荧光原位杂交技术检测非小细胞肺癌EGFR基因扩增

目的探讨荧光原位杂交(FISH)技术检测非小细胞肺癌(non-small cell lung cancer,NSCLC)表皮生长因子受体(epider-mal growth factor receptor,EGFR)基因扩增的临床应用价值。方法采用FISH技术检测57例人NSCLC石蜡组织标本中EG-FR基因扩增水平。对于EGFR基因扩增阳性的患者采用酪氨酸激酶抑制剂(tyrosine kinase inhibitors,TKIs)药物进行治疗,其余患者采用传统化疗进行治疗。结果 57例NSCLC患者中有18例EGFR基因扩增阳性(31.58%),其中12例为高多体性扩增(66.67%),5例为成簇扩增(27.78%),以肺腺癌为主(72.22%)。TKIs靶向药物治疗有效率(RR)、中位生存时间(MST)和1年生存率分别为61.11%1、3.5个月和55.56%,对照组分别为35.89%、7.6个月和33.33%,差异均有显著性(P<0.05),前者的疾病控制率(DCR)高于后者,但差异无统计学意义(P>0.05)。结论使用FISH技术检测NSCLC患者EG-FR基因扩增水平可以为临床采用TKIs药物治疗提...     

ALK阳性晚期非小细胞肺癌临床病理分析

目的 探讨间变性淋巴瘤激酶(anaplastic lymphoma kinase,ALK)在晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)中的表达,及其与临床特征、鉴别诊断、预后的关系.方法 采用免疫组化法检测253例晚期NSCLC中ALK的表达,并对其中132例进行荧光PCR法验证.结果 采用免疫组化法检测晚期NSCLC中ALK阳性率为20.95％(53/253).ALK阳性组中未吸烟者、腺癌的比例高于ALK阴性组(P＜0.05).132例进行荧光PCR验证,免疫组化与荧光PCR符合率随免疫组化阳性程度的增加而递增.结论 免疫组化可作为ALK的筛查手段,提高ALK的检出率.荧光PCR检测对ALK阳性NSCLC的确诊具有重要意义.     

The profile of hMLH1 methylation and microsatellite instability in colorectal and non-small cell lung cancer

Microsatellite instability (MSI) is caused mainly by dysfunction of hMLH1, where aberrant hypermethylation (HM) of its promoter region is involved. Previously, we suggested that HM in the proximal region of the hMLH1 promoter plays a critical role in progression of gastric cancer with MSI and this specific region should be analyzed for diagnostic use of hMLH1 HM. We expanded the analyses of hMLH1 HM and MSI phenotype to sporadic colorectal cancer (CRC) and non-small cell lung cancer (NSCLC) to further evaluate the diagnostic value of hMLH1 HM. A total of 174 CRC and 94 NSCLC samples were used for hMLH1 methylation analysis by real-time methylation-specific PCR. Methylation levels were measured in three distinct regions of the promoter, designated as hMLH1-A, hMLH1-B, and hMLH1-C from distal to proximal. MSI phenotype was determined using five microsatellite markers, BAT25, BAT26, D2S123, D5S346, and D17S250. Methylation profile of the hMLH1 promoter varies between CRC and NSCLC. High methylation levels were observed in a group of CRC samples. Consequently, three patterns of methylation in the hMLH1 promoter regions were found: 1) low methylation level in all regions, 2) high methylation level in hMLH1-A with low methylation level in hMLH1-C, 3) high methylation level in all regions. In contrast, only one NSCLC showed high methylation level in hMLH1-A. Of the 134 CRCs examined, 14 (10.4%) showed MSI phenotype. No MSI phenotype was found in the initial 80 NSCLCs analyzed. Eight (57.1%) of 14 CRC with MSI showed HM in hMLH1-C, which was linked exclusively with MSI phenotype. However, the HM in hMLH1-A or -B was not sufficient for MSI. CRC with MSI phenotype was significantly more frequent in older patients and in the proximal colon, and was more evident in cases with hMLH1-C HM. The results suggested that hMLH1 HM cannot be used as an alternative diagnostic marker of MSI phenotype in sporadic CRC and NSCLC. CRC with MSI might have clinicopathologically distinct subgroups according to hMLH1-C HM status. The observed profiles of hMLH1 methylation and MSI in gastric cancer, CRC, and NSCLC were quite different from each other, facilitating the better understanding of the pathogenesis of these cancers.