非小细胞肺癌患者淋巴结、外周血及骨髓微转移分子诊断在肺癌外科治疗中的作用

目的 探讨检测肺癌患者区域淋巴结、外周血和骨髓中微转移在肺癌外科治疗中的临床意义，以及区域淋巴结、外周血和骨髓肺癌微转移三者之间的相关性。方法 应用巢式RT－PCR技术，对29例肺癌患者和11例肺良性病变患者的淋巴结、外周血和骨髓中CK19基因mRNA表达进行联合检测。结果 本实验建立的巢式RT－PCR技术的敏感性可达到10^-6。术前10例患者检测到外周血微转移，6例患者检测到骨髓肺癌微转移，101枚纵隔淋巴结中55枚检测到肺癌微转移。肺癌患者淋巴结、外周血和骨髓中微转移阳性检出率分别为54．5％、34．5％和20．7％，三者之间存在显著正相关（P＜0．05），外周血和骨髓微转移与肺癌组织学类型、细胞分化程度及P－TNM分期均存在密切关系（P＜0．05或P＜0．01）。结论 RT－PCR法是一种特异性，敏感性均较高的肿瘤微转移检测方法；检测CK19 mRNA表达应用于肺癌微转移的分子诊断有助于选择外科手术适应证，并具有广阔的临床应用前景。

Clinical significance of molecular diagnosis of micrometastasis in lymph nodes, peripheral blood and bone marrow in the surgical treatment of patients with non-small cell lung cancer

Objective To explore the clinical significance of detecting micrometastasis in lymph node, peripheral blood and bone marrow from patients with lung cancer for selection of surgical indication and the correlation among them. Methods The CK19 mRNA expression was detected in lymph nodes, peripheral blood and bone marrow from 29 lung cancer patients and 11 benign pulmonary lesion patients by nested RY PCR. Results The sensitivity of RT PCR technique was 10 -6 in this study. The positive rate of CK19 mRNA were 54.5% (55/101), 34.5% (10/29) and 20.7% (6/29) in lymph node, peripheral blood and bone marrow from lung cancer patients respectively, and a highly positive correlation existed among the three groups (P<0.05). The micrometastasis in peripheral blood and bone marrow were closely related to the pathological classification, cell differentiation of the cancer and P TNM stage of the disease (P<0.05 or P<0.01).Conclusion RT PCR technique is a specific and sensitive method to detect micrometastasis in patients with lung cancer. The detection of CK19 mRNA might have important clinical significance in molecular diagnosis and surgical indication in patients with lung cancer.