【摘要】：目的：化療是治療晚期肺鱗癌的重要手段之一,目前缺乏有效療效的預(yù)測因子。通過分析Ki-67在肺鱗癌中的表達(dá)水平與化療療效及預(yù)后的關(guān)系,探討Ki-67能否作為肺鱗癌的療效預(yù)測因子和生存預(yù)后因子。方法：收集中國人民解放軍總醫(yī)院2007年1月—2014年12月收治的局部晚期或轉(zhuǎn)移性肺鱗癌患者信息,共128例。將病理標(biāo)本重新染色,判讀Ki-67指數(shù)。根據(jù)Ki-67的表達(dá)分為陽性組和陰性組。對患者的臨床特征、治療情況和生存期等進(jìn)行統(tǒng)計,并分析Ki-67的不同表達(dá)與化療療效和生存的關(guān)系�；煰熜гu價采用RECIST 1.1的標(biāo)準(zhǔn)。統(tǒng)計采用SPSS19.0軟件進(jìn)行。結(jié)果：128例患者,中位年齡58歲,Ⅲ期患者75例(58.6%),Ⅳ期患者53例(41.1%),高-中分化鱗癌為50例(39.1%),低分化為78例(60.9%)。一線接受吉西他濱聯(lián)合鉑類治療的75例(58.6%),多西他賽聯(lián)合鉑類的42例(32.8%)。Ki-67的陽性表達(dá)為86例(67.2%),高表達(dá)的Ki-67指數(shù)與肺鱗癌較晚的臨床分期和較差的病理分化有關(guān)。128例患者中,部分緩解(PR)患者為56例(43.8%),病情穩(wěn)定(SD)為54例(42.2%),病情進(jìn)展(PD)為18例(14%),客觀緩解率(ORR)為43.8%。Ki-67的陽性表達(dá)組中,客觀有效率為55.8%,Ki-67陰性組客觀有效率為19.1%,P0.01。單因素分析中,Ki-67≥50%提示較差的無進(jìn)展生存(3.8個月vs 5.7個月,P0.01)及總生存(12.1個月vs 20.1個月,P=0.005)。在多因素分析中,淋巴結(jié)轉(zhuǎn)移和年齡≥60歲,提示較差的總生存;既往行放射治療患者的預(yù)示著較好的總生存;Ki-67≥50%在預(yù)測無進(jìn)展生存(HR 2.384,95%CI:1.556-3.653,P0.01)和總生存(HR 1.981,95%CI:1.181-3.322, P=0.01)中可以作為一個獨(dú)立預(yù)后因素。結(jié)論：Ki-67的高表達(dá)與臨床分期和病理分化程度有關(guān)。Ki-67的高表達(dá)與晚期肺鱗癌化療敏感性相關(guān)。Ki-67的高表達(dá)是肺鱗無進(jìn)展生存和總生存的獨(dú)立預(yù)后因素。
[Abstract]:Objective: chemotherapy is one of the most important methods in the treatment of advanced lung squamous cell carcinoma. By analyzing the relationship between the expression of Ki-67 in lung squamous cell carcinoma and the curative effect and prognosis of chemotherapy, we discussed whether Ki-67 can be used as a prognostic factor and a prognostic factor of lung squamous cell carcinoma. Methods: 128 patients with locally advanced or metastatic squamous cell carcinoma of lung were collected from January 2007 to December 2014 in the General Hospital of the Chinese people's Liberation Army. The pathological specimens were re-stained and Ki-67 index was determined. According to the expression of Ki-67, it was divided into positive group and negative group. The clinical features, treatment status and survival time of the patients were statistically analyzed, and the relationship between Ki-67 expression and chemotherapeutic efficacy and survival was analyzed. The efficacy of chemotherapy was evaluated by RECIST 1.1 standard. SPSS 19.0 software was used for statistics. Results the median age of 128 cases was 58 years old, 75 cases (58.6%) of stage 鈪，

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